Borderline personality disorder and addiction, or substance use disorder, are often co-occurring disorders.
Treating patients with these co-occurring disorders can be challenging, but through the use of dialectical behavior therapy and addiction treatment, patients can learn to lead a healthy life and manage their diagnoses.
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a mental illness that affects a person’s control over their emotions. This can cause extreme mood swings, rapid shifts in feelings for others, and changes in how a person views themselves, among other symptoms.
How Are Borderline Personality Disorder & Addiction Related?
While studies do not suggest that borderline personality disorder causes substance use disorder or vice versa, there is a clear overlap between the two disorders.
According to a 2014 study, about 78 percent of adults suffering from borderline personality disorder also develop a substance addiction or problem during their lifetime.
According to a review of data relating to borderline personality disorder and addiction from 2018, about 46 percent of people dealing with borderline personality disorder also had a substance use disorder. The same review found that around a quarter of people with a substance use disorder met the criteria for borderline personality disorder.
The review also found a similar lifetime substance use disorder rate when compared to the 2014 study but found the rate to be about 75 percent.
Some studies suggest that there is a genetic link between borderline personality disorder and substance use disorder. Some studies may also suggest that personality traits, such as being impulsive or having difficulty controlling emotions, can increase the likelihood of both disorders, which may explain their high rate of overlap.
Finally, studies suggest that a person’s environment early in life may contribute to the development of both disorders.
Common Drugs Abused by People With Borderline Personality Disorder
The three most common drugs abused by those suffering from borderline personality disorder are alcohol, opioids, and cocaine.
A review of multiple studies regarding borderline personality disorder and substance abuse found that 16.99 percent of people diagnosed with alcohol use disorder also had borderline personality disorder.
Across studies, about 46 percent of people suffering from borderline personality disorder had an ongoing alcohol use disorder, while just under 60 percent of those with borderline personality disorder develop an alcohol use disorder at some point in their lives.
The same review found that just over 22 percent of those with a cocaine use disorder and almost 34 percent of those with an opioid use disorder also had borderline personality disorder. The review also found that about 39 percent of those suffering from borderline personality disorder currently have a drug use disorder.
What Is the Treatment for BPD?
Borderline personality disorder is primarily treated by a specialized mental health professional.
While there is no specific medication that can cure or fix borderline personality disorder, some doctors may use medication as part of a treatment plan, especially to treat or alleviate symptoms. There is no cure for the disorder, but it can be successfully managed.
Common symptoms of borderline personality disorder, such as depression or mood shifts, may be alleviated by medications prescribed by a medical professional. Such medications may include selective serotonin reuptake inhibitors, which are generally used as antidepressants.
According to the National Institute of Mental Health, the primary way to treat borderline personality disorder is through different forms of psychotherapy. Studies have found that people with borderline personality disorder who choose not to seek treatment may develop other mental illnesses or experience a worsening of their existing ones.
Psychotherapy involves a patient meeting with a licensed mental health professional either in a private or group session, or a combination of both.
Dialectical Behavior Therapy
The most common form of psychotherapy used to treat those with borderline personality disorder is known as dialectical behavior therapy (DBT).
Generally, there are three parts that make up a full treatment of dialectical behavior therapy for patients.
Skills Training Groups
The skills training group part of dialectical behavior therapy consists of group meetings with the express goal of teaching people dealing with borderline personality disorder social skills that are affected by the disorder. These sessions generally take place for two hours each week.
Skills training groups consist of four modules:
- Core mindfulness: This module focuses on the person living in the moment and taking purposeful action instead of resorting to instinctive or impulsive actions.
- Interpersonal effectiveness: This module focuses on teaching people how to foster healthy relationships and set personal boundaries with other people.
- Emotion regulation: This module focuses on avoiding extreme emotions. It teaches people to place themselves in situations that are more likely to elicit positive emotions from them.
- Distress tolerance: This module focuses on teaching people to accept that problems will occur and learn how to deal with them when they do.
The individual psychotherapy part of dialectical behavior therapy involves the client meeting with their therapist on a weekly basis. Within these sessions, the following six aspects are addressed:
- Parasuicidal behaviors: This addresses a client’s harmful physical tendencies.
- Therapy-interfering behaviors: This is meant to ensure clients remain in therapy by addressing problems that may affect the quality of treatment.
- Quality of life-interfering behaviors: This addresses aspects of a client’s life that may be dangerous, including substance abuse.
- Behavioral skills acquisition: This reinforces what is learned in group sessions regarding interactions with others as well as general skills that are used daily.
- Post-traumatic stress behaviors: This addresses past trauma, which many people with borderline personality disorder enter treatment with.
- Self-respect behaviors: This addresses clients’ self-worth and how they view themselves.
This part of dialectical behavior therapy consists of the clients calling their therapist outside of their allotted time together.
Clients are encouraged to call their therapists before engaging in self-harm. With some forms of DBT, clients are not allowed to call their therapist for a full day after engaging in self-harm. This is meant to teach clients to ask for help before engaging in harmful behavior, not after.
Due to the sensitive nature of this form of treatment, many therapists choose not to engage in telephone consultation, or they set strict limits and guidelines.
Therapist Consultation Team
Due to the nature of dialectical behavior therapy, therapists themselves are encouraged to have group meetings weekly in order to maintain a high standard of care for their clients. This can also help to prevent stress from interfering with treatment.
Why Is Treatment for Co-Occurring Disorders Important?
While both borderline personality disorder and substance use disorder are harmful and dangerous on their own, a combination of the two disorders can be even more dangerous when left untreated.
Impulsive tendencies, self-harm, and suicidal tendencies, all of which are common symptoms of borderline personality disorder, may be worsened by the presence of a substance use disorder. People who have both borderline personality disorder and a substance use disorder may find treatment more difficult than those who only have one of the two disorders.
According to the Substance Abuse and Mental Health Services Administration, those suffering from co-occurring disorders are more likely to be hospitalized than those with only one disorder. As a result, comprehensive treatment is even more important for this group.
Treating both disorders as a part of one treatment plan can lead to better outcomes for the individual. If only one issue is addressed, it’s unlikely that the person will experience full and sustained recovery on either front.
Many treatment programs are equipped in treating people with co-occurring disorders, such as borderline personality disorder and substance abuse. Seek out a specialized treatment program that is experienced in treating dual diagnoses.
Borderline Personality Disorder. (April 2022). National Institute of Mental Health.
Borderline Personality Disorder and Comorbid Addiction. (April 2014). Deutsches Ärzteblatt International.
Borderline Personality Disorder and Substance Use Disorders: An Updated Review. (September 2018). Borderline Personality Disorder and Emotion Dysregulation.
An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. (Fall 2014). Substance Abuse and Mental Health Services Administration.
Dialectical Behavior Therapy as Treatment for Borderline Personality Disorder. (March 2016). The Mental Health Clinician.
The Case for Screening and Treatment of Co-Occurring Disorders. (June 2022). Substance Abuse and Mental Health Services Administration.