Borderline Personality Disorder and Addiction

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bpd and drug abuseBorderline personality disorder, or BPD, is a debilitating condition that is often misrepresented in popular culture and misunderstood by the general public. BPD distorts the individual’s self-perception and interferes with their ability to maintain stable relationships. Those who suffer from BPD are seen as highly manipulative, dependent and dramatic, but mental health professionals understand that this behavior arises as a dysfunctional way to cope with overwhelming fear and emotional pain. The pain, emotional instability and impulsive behavior of borderline personality disorder place these individuals at risk of drug or alcohol abuse.

The relationship between BPD and addiction is a volatile one. The use of drugs and alcohol aggravate some of the more dangerous symptoms of BPD, most notably, rage and depression. Those who have BPD are more likely to engage in drug or alcohol consumption as an attempt to numb the pain of their fear of abandonment.

In order to overcome a profound sense of emotional emptiness, they frequently engage in self-injuring behaviors, like cutting. They are also prone to suicide attempts, especially when substance abuse is involved. If you or someone you care about has been diagnosed with BPD and addiction, getting professional help may literally be a life-saving intervention.

What Causes Borderline Personality Disorder?

Although the origins of BPD remain unknown, there are several theories about how this complicated personality disorder begins, notes the Mayo Clinic:

  • A dysfunctional family environment. Children who grow up in families where they feel emotionally neglected or abandoned are more likely to develop BPD as adults. The trauma of physical or sexual abuse may also contribute to borderline personality disorder.
  • Hereditary factors. BPD and other personality disorders are often seen in close family members, such as parents and their children or siblings. This indicates that certain individuals may have a genetic predisposition to BPD.
  • Neurological factors. The impulsivity, emotional instability and unpredictable behavior of BPD may be caused by abnormalities in the areas of the brain that control mood, behavior and emotions.
  • Brain chemistry. BPD may be linked to imbalances in certain neurotransmitters, naturally produced chemicals like serotonin that affect the way you feel and behave. People with BPD may not process these chemicals normally.

Many of the environmental and neurological factors that contribute to BPD also play a part in substance abuse. Many individuals who struggle with drug or alcohol addiction come from households where heavy drinking or drug use was the norm. A history of childhood sexual abuse or trauma increases the risk of substance abuse later in life, as the individual looks for ways to bury feelings of pain and anger. And according to Neuropharmacology, neurological imaging studies indicate that addiction is related to brain structure and function.

How Do BPD and Addiction Overlap?

When it comes to treating BPD and addiction concurrently, the similarities between addiction and borderline personality disorder make a proper diagnosis difficult. Treatment is particularly challenging in the case of BPD where the individual’s anti-social and manipulative tendencies make the difficult to work with. Further confusing matters is the fact that several signs of drug and alcohol addiction are very similar to symptoms of BPD:

  • Both are characterized by impulsive, self-destructive behaviors.
  • Both may be characterized by mood swings ranging from severe depression to manic periods of intense energy.
  • Both may be characterized by manipulative, deceitful actions.
  • Both may be characterized by a lack of concern for one’s own health and safety and an insistence on pursuing dangerous behavior in spite of the risks.
  • Both are often characterized by a pattern of instability in relationships, jobs and finances.


Suicidal behavior, moodiness, depression and paranoia are all symptoms commonly associated with drug and alcohol addiction. This is what makes treating a Dual Diagnosis such as this difficult at a traditional rehab facility. Unless the facility offers individualized treatment plans for Dual Diagnosis patients, they will not have the resources to handle BPD as a co-occurring disorder.

How Is BPD Treated?

Woman with BPDTreating borderline personality disorder is notoriously challenging. Clients with BPD may make unrealistic demands of their therapists and require constant contact with their treatment team. They may come across as needy and dependent because of their tendency to search for caretakers who can fulfill their emotional needs. To make treatment more difficult, individuals with BPD can turn against their providers, becoming hostile and paranoid without any apparent reason. Understanding the emotional landscape of borderline personality disorder is a must for professionals who treat this serious psychiatric illness.

One of the most successful approaches to treating both BPD and substance abuse disorders is Dialectical Behavior Therapy, or DBT. Based on the principle that change can be balanced with self-acceptance, DBT helps individuals with severe psychiatric disorders build meaningful, stable lives.

DBT has been used effectively to help self-destructive, emotionally unstable patients learn how to regulate their emotions and motivate themselves to change, even under the most difficult of circumstances. According to Addiction Science & Clinical Practice, treatment goals of Dual Diagnosis therapy for DBT include:

  • Helping the client find the motivation to make significant changes in her life
  • Teaching the client to manage moods and handle triggers through practical skills like mindfulness training
  • Eliminating the environmental cues and social connections that promote substance abuse
  • Reducing the craving to drink or abuse drugs
  • Identifying and pursuing meaningful, self-affirming activities that provide a sense of connection to others
  • Helping the client achieve set and achieve manageable recovery goals, like staying sober for 24 hours at a time
In addition to individual psychotherapy for BPD, clients who receive integrated treatment attend classes and counseling sessions in relapse prevention. Relapse prevention training is vitally important in Dual Diagnosis rehabilitation, where relapse rates are high. Relapse prevention often involves peer group support sessions, where clients who have been diagnosed with BPD and addiction can share coping strategies and discuss the challenges of living with this co-occurring disorder.

With a condition like BPD that impairs your social and emotional life, it’s not always enough to rely on psychotherapy and counseling for support. Psychiatric medication and anti-addiction drugs can also be powerful tools in a comprehensive treatment plan. Many BPD patients benefit from medications that restore balanced levels of neurotransmitters, like antidepressants in the SSRI (selective serotonin reuptake inhibitor) class.

 

Anti-addiction medications like methadone, naltrexone and buprenorphine can curb intense cravings for alcohol or opiate drugs.

Reaching Out for Help

If you or someone in your life has borderline personality disorder and is also caught in the grips of drug or alcohol addiction, contact us today. We have the expert professionals on staff to help sort through both conditions, and provide integrated care to the individual. This is top-notch care for those who need it most; Dual Diagnosis treatment is what we do best.

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Further Reading About Borderline Personality Disorder and Addiction