Borderline personality disorder (BPD) has very high comorbidity with substance use disorders. BPD includes lack of impulse control and intense and unstable emotions. It is thought that substance use disorder (SUD) is often a manifestation of the symptoms of BPD.
The Symptoms of BPD
BPD has a negative impact on self-image and relationships with others. Those with BPD often have an intense fear of abandonment. They struggle with control of their emotions and actions, so they often engage in behaviors that push loved ones away, which can increase the fear of abandonment.
Abandonment may be real or perceived. They may ignore personal boundaries in an attempt to stop others from abandoning them. Instability appears in several forms.
There’s a pattern of idealizing and demonizing loved ones. They will perceive someone as perfect, and then quickly switch to believing that they are cruel or abandoning them. They may frequently feel empty, and depend on others to help manage these feelings.
The person may lack a stable sense of identity. Goals, beliefs, and values may shift very quickly. Their belief in their own value as a person can also fluctuate. This can cause them to believe that they are bad or that they don’t fully exist. Moods will shift quickly as well. These include intense happiness, shame, anxiety, and anger. These extreme emotions can also lead to self-harming or suicidal behavior.
In periods of extreme stress, a person with BPD may lose contact with reality for a short time. This can cause extreme paranoia.
Impulsive and Inappropriate Behavior
The symptoms of BPD that have the strongest correlation with SUD are impulsivity and inappropriate behavior. They are more likely to engage in risky behaviors, including gambling, sex, and drug use. They are more likely to engage in behaviors or drug use to the extreme. They are also likely to engage in inappropriate behaviors. This can include inappropriate displays of anger like physical violence or verbal abuse.
The tendency for self-harming behavior can also manifest as more extreme drug use, sabotaging relationships, and employment.
BPD and Addiction
BPD affects nearly 3% of adults; 78% of adults with BPD also have a substance use disorder. They show greater impulsivity and instability than those who do not have co-occurring BPD with addiction. They are more likely to have suicidal tendencies. They have shorter periods of sobriety, and they are more likely to discontinue recovery treatment.
Impulsivity is only a part of the overall correlation with BPD and addiction. Drugs are often used to self medicate. BPD brings many distressing feelings and high amounts of stress.
It is reasonable to believe that drugs are often sought as a way to deal with these negative emotions. Over time, the drug use itself causes problems in the person’s life, which creates more negative feelings. A cycle of use begins. Drugs are used to cope with emotions. The emotional problems increase, which leads to more drug use.
Studies show that 38% of people with a mental disorder who have used drugs during the past year did so as a way to self medicate. This includes those who use drugs casually as well as those with a substance use disorder. Among those diagnosed with a mental disorder and substance use disorder, 34% reported using drugs to self-medicate.
Treatment for BPD and SUD
It was once nearly impossible for those suffering from BPD and a SUD to get the treatment they needed.
Mental facilities wouldn’t admit patients who were struggling with an addiction, and rehab facilities would not accept those with an untreated mental disorder. Today, professionals understand that both disorders must be treated at the same time to be successful.
Dialectal behavioral therapy, or DBT, is one potential treatment for these co-occurring disorders. DBT has been shown to reduce the need for psychiatric medication and medical care by up to 90% in individuals with BPD.
DBT was designed as a treatment for those with emotional dysregulation. It was originally used to treat suicidal patients. It is believed to be an effective treatment for those with a severe substance use disorder when emotional dysregulation plays a key role in drug use.
There are very few studies of treatments for BPD and co-occurring SUD. Small studies have suggested that DBT increases the patient’s ability to function and periods of sobriety. Despite limited evidence at this time, DBT is recommended for the treatment of BPD and co-occurring SUD.
DBT can be a part of a 12 steps non-religious program. Concepts including mindfulness, acceptance of reality, and distress tolerance are key to 12-step programs and DBT. Forming relationships and connections with peers are also key to both forms of treatment.
DBT teaches the individual how to communicate and be less reactive to others’ actions. The fellowship of a non-religious 12-step program is an excellent place to practice these skills.
