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Borderline Personality Disorder and Addiction

Borderline personality disorder (BPD) is a difficult diagnosis for someone to have. With addiction, it becomes much more difficult to manage and treat. What are your options?

Borderline Personality Disorder

BPD is not the most common diagnosis found in substance use disorder treatment, but it is seen often enough to discuss. What exactly is it? Simply put, this personality disorder causes a large amount of mood lability and behavior instability. It also causes interpersonal distress as the individual desperately tries to manage relationships and get attention from particular people. This typically occurs in a cycle of victimization and explosive irrational emotion. The individual tends to get close with someone, creates an issue, then when the other individual backs off, victimizes themselves to bring the other person back into their good graces. This behavior will occur until the individual does some counseling or the others involved have had enough. In this latter scenario, the individual will look for another person to act out these behaviors. This behavior is usually in response to abandonment issues, whether they are actually occurring or are imagined. Such individuals tend to have poor self-concept. Risky behaviors are also a symptom, hence it's co-occurrence with substance use.

Co-occurring with Substance Use

BPD with co-occurring substance use makes for a very problematic case. While it is not the most common occurrence, it does occur and it becomes problematic to treat. Part of BPD symptomology is relational instability. The most important part of counseling is the relationship. This makes BPD a difficult diagnosis to work on, as the individual may act out symptomatically towards the counselor.  Furthermore, relationship issues frequently occur at the same time as substance use, as the individual continues to use and burn bridges. When combined with the relational instability if BPD, the individual will hemorrhage non-familial relationships quickly and ultimately lose the support of family, potentially much faster than individuals not diagnosed with BDP, as the additional stress of BPD symptomology will not be present. This is also highly problematic, as substance use is a family condition and family treatment is integral. We recommend treatment for both with a skilled counselor familiar with treatment approaches for both.

Treatment Options

One issue that occurs with any personality disorder is medication is not as common or supported. In this setting, medication is frequently used for approved off label treatment. There is some medication that is approved in this way, but its efficacy is unclear. We recommend a combination of counseling and 12-step recovery to treat this concern. Counseling approaches such as dialectical behavior therapy (DBT) have been specially designed to work with individuals diagnosed with BPD. 12-step meetings for dual diagnosis also exist, and will be extremely useful. Here you will find recovered individuals with co-occurring mental health that will be able to help more so than an individual in a 12-step fellowship without another diagnosis. One saving grace of BPD, is that it tends to go into remission over time. Some studies have shown that BPD symptoms tend to clear up after 15 years, and are gone at 27. That may seem daunting, so in the interim, we recommend counseling to help you learn to cope and manage this condition.

Independent Recovery

At Independent Recovery, we want to see you get the help you need. If you would like more information, please feel free to reach out to us on our Get Stared page. We are happy to provide more information and help connect you to resources as well. So what are you waiting for!