Substance Use

Borderline Personality Disorder & Substance Abuse Counseling

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When it comes to supporting individuals with Borderline Personality Disorder (BPD) who are struggling with substance abuse, counseling is a critical component of treatment. People with BPD often experience intense emotional turmoil and may turn to drugs or alcohol as a way to cope with their overwhelming feelings. Counseling approaches tailored to address both BPD and substance abuse simultaneously are essential for adequate support. (1)

By providing a safe and supportive environment to process past traumas, counselors can help individuals address underlying issues, mental illness, and unstable relationships to reduce the risk of relapse. (2)

Collaborative care involving mental health professionals, substance abuse counselors, and other healthcare providers ensures that treatment plans are comprehensive and tailored to the individual’s unique needs, promoting long-term recovery and a healthier lifestyle. 

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What Is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a complex mental health condition characterized by pervasive patterns of instability in:

  • Interpersonal relationships
  • Self-image
  • Emotions
  • Behavior

Individuals with BPD often experience intense and fluctuating emotions, making it challenging for them to regulate their feelings effectively. (3)

They may also exhibit impulsive behaviors, such as:

  • Reckless spending
  • Substance abuse
  • Self-harm
  • Engaging in risky sexual activities 

Additionally, individuals with BPD may struggle with a distorted sense of self and identity, leading to feelings of emptiness, instability, and uncertainty about their goals, values, and beliefs. (3)

Those with BPD typically navigate through unstable interpersonal relationships. These interactions are often fraught with volatility, swinging between intense idealization and sharp devaluation of others.

Such patterns can strain personal connections considerably, leading to frequent disputes, separations, or challenges in sustaining intimate bonds.

Amid these difficulties lies a profound fear of abandonment among those with BPD; they may exert significant effort to sidestep actual or perceived rejection at all costs. (3)

It is crucial to recognize that Borderline Personality Disorder represents a severe mental health issue that can profoundly affect one’s life quality, functionality, and overall wellness.

Nevertheless, through suitable intervention and ongoing support mechanisms in place for those affected by BPD—encompassing therapy options like Dialectical Behavior Therapy (DBT)—it is possible for many to regulate their symptoms more effectively. (3)

What Are the Symptoms of Borderline Personality Disorder?

The symptoms of BPD and substance abuse are very similar:

  • Self-destructive actions
  • Extreme mood swings
  • Low self-esteem
  • Troubled personal relationships
  • Risky or dangerous behavior

This can make it difficult to diagnose the two conditions separately. (4)

The misuse of drugs and alcohol can make the erratic behavior of people with BPD even more extreme, and it is often a challenge to get them to enter rehab and complete treatment.

People with BPD often have feelings of isolation, depression, and loneliness, have trouble feeling empathy for others, have a persistent, ongoing fear of being abandoned, and are often hostile toward those around them. (4)

These symptoms can manifest in various ways, impacting both the individual’s emotional well-being and their interactions with others:

  1. Self-Destructive Actions: Individuals with BPD may engage in self-harming behaviors such as cutting, burning, or other forms of self-injury as a way to cope with emotional distress.
  2. Extreme Mood Swings: Intense and rapidly shifting emotions are common in BPD, leading to periods of euphoria followed by deep despair or anger. (5)
  3. Low Self-Esteem: People with BPD often struggle with a chronic sense of worthlessness, inadequacy, or self-loathing, which can contribute to an unstable self-image.
  4. Troubled Personal Relationships: Individuals with BPD may have tumultuous relationships characterized by intense idealization and devaluation of others, leading to frequent conflicts, breakups, or difficulties in maintaining stable connections.
  5. Risky and Dangerous Behavior: Impulsive actions such as reckless driving, substance abuse, alcohol abuse, binge eating, or unprotected sex are common in individuals with BPD, often driven by a desire to alleviate emotional pain or seek stimulation. (6)
  6. Feelings of Isolation and Loneliness: Despite the desire for connection, people with BPD may feel chronically lonely and misunderstood, leading to a sense of isolation from others.
  7. Difficulty Feeling Empathy: Individuals with BPD may struggle to empathize with others’ emotions or perspectives, making it challenging to maintain healthy interpersonal relationships.
  8. Fear of Abandonment: There is often an intense fear of abandonment in individuals with BPD, leading to efforts to avoid real or perceived rejection and abandonment by loved ones.
  9. Hostility and Anger: Feelings of anger, irritability, or hostility are common in individuals with BPD, often stemming from perceived slights or threats to their sense of self. (7)
  10. Depression and Anxiety: Co-occurring mood disorders such as depression and anxiety are prevalent among individuals with BPD, exacerbating emotional instability and distress. (8)

How Is Borderline Personality Disorder Diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders has determined that if five of these criteria are met, a person is diagnosed with borderline personality disorder: (9)

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating)
  • Recurrent suicidal behavior, gestures, or threats
  • Self-mutilating behavior
  • Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, or recurrent physical fights
  • Transient, stress-related paranoid ideation or severe dissociative symptoms

What Causes Borderline Personality Disorder?

The Mayo Clinic recently issued a report that cites several factors that may contribute to BPD: (10)

  • Brain chemistry: BPD may be caused by imbalances in naturally produced chemicals in the brain that affect the way you behave and think. (11)
  • Hereditary factors: Some people have a genetic predisposition for BDP. Close family members, such as parents and children, often share a risk of the disorder. (12)
  • Dysfunctional family environment: Physical or sexual abuse may trigger BPD. Children who feel abandoned or neglected are at high risk of developing the disorder as they get older. However, as a disclaimer, this will vary based on the specific situation. For the general population, these causes can affect someone.

Risk Factors For Borderline Personality Disorder

While the exact causes of BPD are not fully understood, several factors contribute to the development of this complex mental health condition:

  1. Genetic Factors: Research suggests that genetics play a significant role in the development of BPD. Individuals with a family history of BPD or other mental health disorders, such as mood disorders or substance use disorders, are at a higher risk of developing the condition themselves. Genetic predispositions may interact with environmental factors to influence the expression of BPD traits. (12)
  2. Early Childhood Trauma: Traumatic experiences during childhood, such as physical, emotional, or sexual abuse, neglect, or prolonged exposure to chaotic or unstable environments, significantly increase the risk of developing BPD later in life. These adverse childhood experiences can disrupt normal emotional development and lead to difficulties in regulating emotions and forming secure attachments. (13)
  3. Invalidating Environments: Growing up in an invalidating or invalidating environment where one’s emotional experiences are dismissed, ignored, or invalidated can contribute to the development of BPD. Invalidating environments may prevent individuals from learning healthy coping strategies for managing emotions and communicating effectively, leading to heightened emotional reactivity and instability.
  4. Neurobiological Factors: Changes in brain structure and function have been observed in individuals with BPD, particularly in regions involved in emotion regulation, impulse control, and social cognition. Dysregulation of neurotransmitter systems, such as serotonin and dopamine, may also contribute to the emotional instability and impulsive behavior characteristic of BPD. 
  5. Temperamental Factors: Certain personality traits, such as high levels of impulsivity, emotional sensitivity, and reactivity, may predispose individuals to developing BPD. These temperamental factors, combined with environmental stressors, can contribute to the onset and persistence of BPD symptoms.
  6. Substance Abuse: Substance abuse, particularly during adolescence or early adulthood, is commonly associated with BPD. Individuals may use drugs or alcohol as a way to cope with emotional distress or regulate mood, exacerbating BPD symptoms and complicating treatment efforts. Sometimes, alcohol use disorders or drug abuse develops, which can further complicate things.
  7. Co-occurring Mental Health Disorders: BPD frequently co-occurs with other mental health disorders, such as depression, anxiety disorders, post-traumatic stress disorder (PTSD), and eating disorders. The presence of these comorbid conditions can exacerbate BPD symptoms and increase the overall severity of the disorder. (14)

The Relationship Between Borderline Personality Disorder And Addiction

The relationship between Borderline Personality Disorder and drug addiction is complex and multifaceted, often involving intertwined patterns of behavior, emotion dysregulation, and underlying psychological vulnerabilities.

  1. Shared Risk Factors: BPD and addiction share several common risk factors, including genetic predispositions, early childhood trauma, invalidating environments, and temperamental factors such as impulsivity and emotional dysregulation. These shared vulnerabilities can predispose individuals to develop BPD, dissociation, suicide attempts, and addiction simultaneously or sequentially. (15)
  2. Self-Medication: Many individuals with BPD turn to substance abuse as a form of self-medication to cope with overwhelming emotional distress, impulsivity, and interpersonal difficulties. Drugs and alcohol may temporarily alleviate symptoms of BPD, providing a sense of relief or escape from intense emotional pain. However, substance abuse ultimately exacerbates BPD symptoms and can lead to a vicious cycle of addiction and worsening mental health. (16)
  3. Emotional Dysregulation: The landscapes of BPD and significant challenges in managing emotions often mark addiction. Those with BPD typically navigate through a whirlwind of intense, fluctuating feelings that can spark impulsiveness, mood swings, and actions harmful to oneself. Addiction mirrors this dysregulation through disrupted reward systems in the brain, fostering an uncontrollable urge for substance use despite its adverse effects. When BPD coexists with addiction, this emotional turbulence intensifies, complicating individuals’ abilities to deal with stressors and triggers effectively.
  4. Impaired Judgment: The confluence of BPD and addictive behaviors tends to undermine one’s ability to make sound decisions. This impairment frequently manifests as engaging in substance misuse as an ill-advised strategy for alleviating emotional distress or pursuing immediate pleasure without heed to future ramifications. Such impaired judgment fuels the vicious cycle of addiction while magnifying the difficulties inherent in navigating BPD symptoms.
  5. Treatment Challenges: Treating co-occurring BPD and addiction presents unique challenges due to the complex interplay of psychological, biological, and social factors involved. Comprehensive treatment approaches that address both conditions simultaneously are essential for promoting recovery and improving overall well-being. Integrated therapies, such as Dialectical Behavior Therapy (DBT) modified for substance abuse, can help individuals develop coping skills, regulate emotions, and reduce addictive behaviors.

Additionally, addressing underlying trauma, improving interpersonal relationships, and providing support for relapse prevention are critical components of treatment for individuals with co-occurring BPD and addiction.

How We Treat Borderline Personality Disorder And Substance Abuse

To effectively treat BPD and substance abuse, a comprehensive approach is key. Here’s how we approach treatment:

  1. Dialectical Behavior Therapy (DBT): DBT is central to treatment for BPD. It focuses on teaching skills like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills help individuals manage intense emotions, navigate relationships, and cope with life’s challenges. (17)
  2. Addressing Substance Abuse: DBT provides tools to address the emotional dysregulation and impulsivity underlying substance abuse. It helps individuals recognize triggers and cravings, develop healthier coping strategies, and prevent relapse. Additionally, therapy sessions, substance abuse treatment, and support groups tailored explicitly for substance abuse educate individuals about addiction and provide strategies for recovery.
  3. Integrated Treatment: Treatment plans should integrate various approaches, including medication management, individual and group therapy, and family therapy. These approaches address both BPD and substance abuse simultaneously, providing comprehensive in-patient support for recovery. (18)
  4. Co-occurring Mental Health Issues: Addressing co-occurring mental health issues like depression, anxiety, or trauma-related symptoms is crucial. By treating these issues alongside BPD and substance abuse, individuals receive holistic care that considers all aspects of their well-being. (19)

By incorporating these interventions into treatment plans, individuals with BPD and substance abuse can develop the skills, resilience, and support networks needed for lasting recovery and improved quality of life.

Get the Treatment Options You Need For You Bipolar Disorder or Co-Occurring Disorders

Seeking professional guidance and collaborating with healthcare providers can help individuals develop a comprehensive treatment plan that addresses their unique challenges and supports their journey toward stability and recovery.

As part of a comprehensive addiction treatment program at Zinnia Health, it stresses the importance of remaining mindful of self-regulating your emotions without resorting to self-harming or using drugs or alcohol. Give us a call today at (855) 430-9439 for more information about you or your loved ones’ mental health conditions.


Call us
Ready to get help?
(855) 430-9439
Why call us? Why call us