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 how the mental health treatment options available.

Does One Disorder Cause Another?

No. Borderline personality disorder doesn’t directly cause addiction or vice versa. However, borderline personality disorder can make an addiction more likely.

The Relationship Between Borderline Personality Disorder and Addiction

People with borderline personality disorder have difficulty regulating their emotions. After experiencing a traumatic or emotionally charged event, they are often left in a state of heightened emotion long after the event has passed. During this time, they’ll experience several negative intrusive thoughts and uncontrollable urges leading to self-harm or impulsive behaviors. Unfortunately, this includes misuse or overuse of substances.

According to the National Institute on Drug Abuse, drugs change the brain in ways that make quitting difficult – even if the person wants to stop. This is how substance use disorder begins, and addiction is the most severe form of a substance use disorder.

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:

• 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:

• 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:

• 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 a Dual Diagnosis

People with dual diagnoses display certain behaviors or physical warning signs related to both conditions. Although the following symptoms are seen in individuals with an addiction and borderline personality disorder, the presence of symptoms alone should never take the place of a professional assessment. This is due to symptoms overlapping or mimicking other mental health conditions.

Signs and Symptoms of Borderline Personality Disorder

Individuals struggling with borderline personality disorder will display the following signs and symptoms:

• Experiencing negative intrusive thoughts
• Making frantic efforts to avoid being abandoned
• Feeling intense bouts of depression or anxiety
• Feeling bored or empty
• Having angry outbursts
• Having problems with impulse control
• Having a negative self-image
• Having difficulty in relationships
• Overreacting to stressors
• Feeling paranoid
• Engaging in self-harm

Signs and Symptoms of Addiction

Individuals with dual diagnosis will display the following signs and symptoms related to addiction:

• Taking risks such as driving under the influence
• Neglecting responsibilities
• Getting into legal trouble
• Acting suspiciously
• Isolating from others
• Sudden mood swings
• Changes in personality
• Increased arrests
• Appearing on edge or anxious

Physical signs of an addiction include:

• Dilated pupils
• Bloodshot eyes
• Unusual body odor
• Insomnia
• Fatigue
• Poor hygiene

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.

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

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. 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).
• 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

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

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.