Borderline Personality Disorder (BPD) and Substance Abuse

Stress is a difficult emotion to process, especially when it is linked to a traumatic or adverse experience. For individuals with borderline personality disorder (BPD), stress can cause them to enter a prolonged state of anxiety or depression and strain their relationships. They often feel isolated and have intrusive thoughts that cause them to act out on impulses like harming themselves or misusing substances.

Unfortunately, this places them at a much higher risk of developing a substance use disorder and, in turn, an addiction.

On this page, you’ll learn how borderline personality disorder and addiction coincide, the warning signs of both, and the mental health treatment options available.

Can BPD Cause Substance Abuse (and Vice Versa)?

BPD and substance use disorders share a complex, bidirectional relationship. Studies from the National Institute of Mental Health indicate that people with BPD experience substance abuse at rates significantly higher than the general population, with estimates suggesting up to 50 percent of those with BPD develop a substance use disorder during their lifetime.[1]

The connection stems largely from BPD’s hallmark features of emotional dysregulation and impulsivity. Many people with BPD turn to substances as a form of self-medication to cope with intense emotions, unstable relationships, and chronic feelings of emptiness.[2] This pattern often creates a cycle where substance use worsens BPD symptoms, leading to increased substance use.

Common manifestations of this co-occurring relationship include:

• Intensified mood swings: Substance use can amplify the emotional instability characteristic of BPD.
• Increased risk-taking behaviors: The combination of BPD impulsivity and substance use leads to more dangerous decisions.
• Relationship difficulties: Both conditions can strain interpersonal relationships and support systems.
• Higher rates of self-harm: Substance use may increase the likelihood of self-destructive behaviors.
• Greater treatment challenges: The presence of both conditions requires specialized care approaches.

Borderline Personality Disorder and Substance Use Disorders: Fast Facts

Several correlations between substance use disorders and borderline personality disorder are well-established through scientific research. The following fast facts highlight a direct link between the two conditions, proving that they often co-occur.

Substance Abuse and Mental Health Services Association:[3]

• Over 40% of those seeking buprenorphine treatment have borderline personality disorder.
• Nearly 50% of individuals with borderline personality disorder have a history of abusing prescription drugs.

American Psychological Association:[4]

• 50% of individuals seeking treatment for borderline personality disorder present with co-occurring post-traumatic stress disorder (PTSD). Both conditions make substance use disorder more likely.

Indian Journal of Psychological Medicine:[5]

• Personality disorders are present in up to 73% of patients treated for addiction.
• Individuals with personality disorders were more likely to have drug use disorder than alcohol use disorder.

Why these conditions are more likely to present together is not fully understood. However, current research concludes that a dual diagnosis is more prevalent in the following populations:

• Individuals with a family history of addiction
• Individuals who were exposed to childhood abuse
• Individuals who have PTSD
• Individuals who were exposed to a traumatic event
• Individuals with impulse control issues
• Individuals with chemical imbalances in the brain
• Individuals with a previous history of alcohol or drug abuse

Signs and Symptoms of Co-Occurring Substance Abuse and BPD

The combination of Borderline Personality Disorder (BPD) and substance use disorders creates a complex set of overlapping symptoms that can intensify each other. Understanding these distinct yet interrelated signs helps in identifying when both conditions occur together.

Common signs of BPD when combined with substance abuse include:[6]

• Extreme fear of abandonment: Intensified panic about being left alone, often leading to increased substance use.
• Unstable sense of self: Difficulty maintaining a coherent identity, worsened by the effects of substances.
• Intense mood swings: Rapid shifts between emotions, amplified by substance use and withdrawal.
• Self-destructive behaviors: Engaging in risky activities beyond just substance use.
• Chronic feelings of emptiness: Using substances to fill a persistent internal void.

Signs that substance use has become problematic in someone with BPD:

• Escalating consumption: Needing more of the substance to achieve the same emotional relief.
• Withdrawal from responsibilities: Declining performance at work or school despite consequences.
• Relationship instability: Substance use creates additional strain on already challenging relationships.
• Failed attempts to quit: Multiple unsuccessful efforts to stop using substances.
• Self-medication patterns: Using substances specifically to manage BPD symptoms.

How Are Co-Occurring Borderline Personality Disorder and Addiction Diagnosed?

A medical doctor, psychologist, or psychiatrist typically assesses a dual diagnosis. In addition to collecting statements from the patient about their concerns, they perform several tests and employ diagnostic tools to determine which conditions are present and how best to treat them.

To diagnose borderline personality disorder or another mental health condition, he or she will:

• Ask questions about the patient’s substance use.
• Gather information about the patient’s family history.
• Perform or refer the patient for a medical exam to rule out other conditions.
• Ask about the patient’s mental health history.
• Assess the patient’s symptoms using the Diagnostic Manual of Mental Disorders, 5th edition (DSM-5), and link them to a diagnosis.[7]

Some mental health professionals use other assessment tools to pinpoint a dual diagnosis.[8]

They include:

• Addiction Severity Index (ASI)
• Psychiatric Research Interview for Substance and Mental Disorders (PRISM)
• Alcohol Use Disorder Identification Test
• Drug Use Disorder Identification Test
• Opioid Risk Tool – OUD (ORT-OUD Chart)
• Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS)
• Mini International Neuropsychiatric Interview (MINI)

Borderline Personality Disorder and Addiction Treatment

Treating someone with symptoms of BPD isn’t easy. According to SAMHSA, individuals displaying symptoms of BPD have difficulty sticking to one therapist or health provider.[9] They often move from therapist to therapist until they find one that “feels right.” This could hinder treatment. Moreover, when a substance use disorder is involved, treatment is further complicated.

For these reasons, it is recommended for anyone with a dual diagnosis of BPD and addiction to work with a team of individuals rather than one person. This team may involve a substance abuse counselor, primary care physician, psychiatrist, group therapist, and an individual therapist.

They will design a plan to fit the patient’s mental health treatment goals.

This plan may involve the following:

• Inpatient Detox: Before embarking on a borderline personality disorder and addiction treatment plan, the person must commit to abstaining from the addictive substance. During this period of abstinence, they may struggle with drug cravings and uncomfortable withdrawal. To address withdrawal syndrome, they may be required to enroll in a residential treatment program to detox under medical supervision. Here, they’ll receive medication if needed and therapy.
• Behavioral Therapy: People with a dual diagnosis require therapy to control their symptoms and to learn what caused their addiction. In these one-on-one sessions, they’ll learn valuable coping strategies, life skills, and intervention methods to counter triggers that cause them to use. The most common form of therapy for people with BPD is dialectical behavior therapy (DBT).[10]
• Medication: Some individuals with a dual diagnosis require medications to control the symptoms of borderline personality disorder. Those with an active addiction may also require medications to reduce drug or alcohol cravings and control withdrawal symptoms.
• Group Therapy: Residents in inpatient programs or those requiring outpatient care may participate in group therapy sessions to continue their recovery goals. In these sessions, they’ll receive peer support to improve communication, motivation to stay the course, and coping strategies.

It’s important to note that there aren’t any FDA-approved medications for BPD, though individuals with this condition may use medications for symptomatic relief.

On the other hand, there are FDA-approved medications for substance use disorders. These medications are provided as part of an inpatient treatment program, though a psychiatrist may also prescribe them.

They include:

• Buprenorphine
• Naltrexone
• Methadone
• Naloxone

Benefits of Dual Diagnosis Treatment for BPD and Substance Abuse

The benefits of mental health treatment for dual diagnosis include:

• Symptomatic relief
• Greater confidence
• Reduced risk-taking
• Better outlook on life
• Improved mental health
• Better communication skills
• Greater sense of awareness

Additional Treatment Modalities For BPD and Addiction

Several treatment approaches work together to create a comprehensive plan for managing co-occurring Borderline Personality Disorder and substance use disorders. Each method targets specific aspects of recovery, helping people develop emotional regulation skills and build support networks for sustained healing.

• Dialectical Behavior Therapy: The gold standard for BPD treatment, helping develop mindfulness and emotional regulation while addressing substance use patterns.
• Group support programs: Structured sessions providing accountability and understanding from others facing similar challenges with BPD and addiction.
• Family therapy: Educational support helping loved ones understand both conditions while improving communication and establishing boundaries.
• Trauma-focused therapy: Specialized treatment addressing underlying experiences that may contribute to both BPD and substance use.
• Mindfulness practices: Techniques including meditation and stress management supporting emotional balance and addiction recovery.
• Medication management: When appropriate, helps stabilize mood while supporting addiction treatment goals.
• Relapse prevention planning: Structured approaches for identifying triggers and developing coping strategies specific to both conditions.
• Skills training: Practical education in distress tolerance, interpersonal effectiveness, and emotional regulation.

Discover Dual Diagnosis Treatment Programs at Engage Wellness Acton

If you’ve been diagnosed with both Borderline Personality Disorder and Substance Use Disorder, you may feel stuck with no end in sight. However, with the right support and mental health treatment options, healing is possible.

At Engage Wellness Acton, we understand the complexities of a dual diagnosis, so we offer a range of inpatient and outpatient programs designed to treat the whole person—mind, body, and spirit. Our residential quarters provide a supportive environment for inpatient care, and we offer evidence-based services to help you on your journey to recovery.

Contact us today; we’ll work together to create the best plan for your needs.

Frequently Asked Questions About Rehab For Borderline Personality Disorder