Can Borderline Personality Disorder Be Treated Concurrently with Addiction?

Most people with borderline personality disorder (BPD) have a substance use disorder at some point in their lifetimes. Using substances can soothe painful emotions, but this relief comes at a cost. Chronic substance use worsens mood over time and increases the risk of accidental or intentional self-injury. Fortunately, people with BPD can receive concurrent treatment for BPD and substance use disorders at integrated treatment programs.

What Is Borderline Personality Disorder?

In the Diagnostic and Statistical Manual of Mental Disorders, BPD is one of the ten personality disorders listed. All ten personality disorders develop by early adulthood and affect how people perceive themselves, socialize and react to stress. Borderline personality disorder is one of the four “Cluster B” personality disorders, which feature traits of emotional instability, impulsivity and externalized stress reactions. Symptoms of BPD include:

• Chronic feelings of emptiness
• A disturbed or unstable sense of self
• Frantic efforts to avoid abandonment
• Recurrent suicidal or self-harming behavior
• A pattern of unstable and intense relationships
• Emotional reactivity and rapidly changing moods

Mental health professionals increasingly recognize BPD as a trauma-related disorder like post-traumatic stress disorder and dissociative disorders. Research shows that from 30 to 90 percent of people with BPD experienced child abuse or neglect and that childhood trauma is a primary cause of BPD.

Borderline Personality Disorder and Addiction

Most people with BPD have one or more co-occurring disorders:

• Approximately 40 percent of people with BPD develop post-traumatic stress disorder
• About 20 percent of people who have BPD also have a bipolar disorder
• Approximately 88 percent of people with BPD also struggle with an anxiety disorder

The rate of co-occurring substance use disorders is even higher. About 78 percent of people with BPD develop a substance use disorder at some point.

People with BPD experience intense and painful emotional reactions, and many behaviors associated with BPD reflect ways of preventing or coping with these reactions. Many people with borderline personality disorder cut themselves; the physical pain is more tolerable than the emotional pain and can temporarily distract from it.

Using substances can be another way to manage or soothe emotional reactions. Some substances induce dissociative states, while others can help people with BPD connect with their emotions in ways they otherwise can’t. Some substances can do both, depending on the context in which they are used.

Unfortunately, these effects are short-lived. The temporary relief of dysphoric moods or anxiety that substance use can provide usually leads to long-term worsening of depression and anxiety symptoms as well as other negative outcomes. People with BPD are already 50 times more likely to commit suicide than people who don’t have BPD, and using substances increases their risk of acting on suicidal thoughts.

If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-866-220-8570.

Treating Co-Occurring Borderline Personality Disorder and Addiction

Psychiatrists once believed that BPD was impossible to treat. However, advances in treatment and research have revealed the opposite. Not only can people with BPD reduce their emotional reactivity, many of them even experience a full remission of symptoms.

Dialectical behavior therapy (DBT) was specifically developed to treat BPD and remains one of the most effective interventions for it. In the first phase of DBT, people learn skills that improve their distress tolerance, emotional regulation, impulse control and interpersonal effectiveness. In the next phase, they move on to do more individualized work in therapy.

Research shows that DBT significantly lowers suicide and hospitalization rates for people with BPD. A specific form of DBT has been developed to treat co-occurring BPD and substance use disorders (DBT-SUD), and research shows that it improves outcomes for both conditions.

The DBT-SUD intervention uses an integrated treatment approach. While earlier approaches to the treatment of co-occurring disorders were based on the idea that substance use disorders had to be treated first, research actually shows that treating substance use and mental health conditions at the same time is more effective.

Several other interventions can effectively treat BPD:

• Trauma-focused therapies like eye movement desensitization and reprocessing therapy (EMDR) can address underlying trauma
• Mentalization-based therapy (MBT), acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can help people with BPD improve their social functioning and emotional stability

Most integrated programs use a variety of interconnected services to address multiple disorders and treatment needs at the same time. At an integrated program, people may participate in treatment groups, individual therapy, complementary therapies and medication management.

The treatment programs at The Recovery Village at Palmer Lake use this integrated approach. If you are struggling with the challenges of co-occurring borderline personality disorders and substance use disorders, you can contact The Recovery Village at Palmer Lake to learn more about integrated treatment. A representative will help you find the best program for your needs.