Dual Diagnosis Treatment: Borderline Personality Disorder and Addiction

A dual diagnosis is when someone experiences a mental health condition as well as an addiction to drugs or alcohol. Many times, addiction and mental health correlate closely. More and more, the medical world is showing the effects mental health issues can really have on someone falling into drug use, or developing a substance use disorder. Dual diagnosis treatment centers in California and all over the United States have treatment programs specifically focused on treatment for these co-occurring disorders

Mental health is not only a growing concern in modern-day society– it’s one of the biggest concerns. Personality disorders are a large subsection of mental illness. It’s a known fact that many types of mental disorders, primarily those of behavioral or personality disorders, coincide with substance abuse. The two go hand-in-hand: this is a topic we talk about nonstop here at Opus Health. Why? Mainly because these things matter. Proper treatment involves looking at the whole person– mental health and all. Borderline personality disorder and addiction can be challenging, both for the person experiencing these diagnoses and the treatment available. But to understand the whole totality of the two, let’s first learn what borderline personality means and what treatment we know about it.
According to the DSM-5, there are three broad categories of major personality disorders:

  1. Cluster A: Eccentric or odd behavior
  2. Cluster B: Dramatic or emotional responses
  3. Cluster C: Fearful and anxious behavior

Borderline personality disorder falls into Cluster C.

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental illness that exhibits intense emotions, unstable self-image, impulsiveness, and often, unstable relationships. It is one of many psychiatric disorders. It usually arises as a means to cope with intense emotional pain, trauma, and/or fear. Furthermore, it often occurs with other mental illnesses including anxiety, depression, and eating disorders.
 About 1-3% of American adults have BPD, so while it’s not common, it’s not exactly rare, either. Though BPD is treatable, it can be difficult to manage because those with BDP can have difficulty perceiving their thoughts or behaviors as abnormal.
Furthermore, because of associated emotional pain, unstable self-image, and fear of abandonment, statistics show that many people with a borderline personality disorder often partake in alcohol and drugs to try and fill the emotional “void”.

Symptoms of Borderline Personality Disorder and Addiction

About 78% of people with BDP have also abused drugs at some point, meaning that BPD and substance abuse are commonly co-occurring. To help show you how linked they are, here is a list of symptoms. Some of these are for substance abuse, others for borderline personality disorder. Can you guess which symptoms belong to which?

  • Impulsive behavior
  • Self-destructive behavior
  • Violent mood swings
  • Manipulative actions
  • Unstable relationships, jobs, or financial situation
  • Lack of concern for their own safety and well-being
  • Pursuing dangerous behavior despite obvious risks

Difficult, right?
It’s not just difficult for you to figure out which symptoms are for BPD and which are for substance abuse, it’s difficult for medical professionals to guarantee effective treatment. That’s because every symptom listed is a symptom of both borderline personality disorder and addiction.

Even the symptoms that are tied to only BPD seem very similar to drug abuse.
  • Paranoia
  • Unstable sense of self
  • Fear of being alone (and doing everything possible to avoid it)
  • Eating disorders
  • Codependency or pattern of toxic relationships
  • Avoiding full self-responsibility

This means that even with all the symptoms present, it’s easy for a professional to miss a diagnosis for BPD or vice versa. However, it’s also quite common for people to have a dual diagnosis for both borderline personality disorder and drug addiction.

Is There Treatment for BPD with Addiction?

Treating BPD, in general, is quite challenging and has remained a continual field of study in psychology. Not only do individuals with BPD appear quite needy most of the time, but they can have highly unrealistic expectations of their caretakers. Because they have a strong tendency to find other people to fill their emotional needs, they often ask a lot from their caretakers. This often results in dependency and constant contact with them.
Furthermore, occasional violent mood swings can cause some to turn against their caretakers for no apparent reason. They have a tendency for paranoia, so that can make these mood swings even worse. For example, a patient might do well with a specific therapist for several months, and then suddenly become aggressive and claim his or her therapist is out to get them somehow.
This means that anyone wishing to help treat patients with borderline personality disorder must understand all the intricacies and the range of emotions involved with the psychiatric disorder. This is specialized knowledge. And the good news is, there are many therapists and specialists out there who are expert professionals in treating BPD.
Unfortunately (and this is seen at many addiction treatment centers), alcohol or drug abuse simply exacerbates these BPD symptoms.
However, there is one method that has shown quite a bit of success for treating both BPD and drug abuse…

Dialectical Behavior Therapy (DBT)

DBT comes from a philosophy called dialectics. Dialectics is the philosophy that everything is a combination of opposite forces. That means all things are interconnected when viewing a holistic individual. (Holistic = the whole self.) A small win in one area of someone’s life makes their entire life better. Furthermore, because there are opposite forces, change is both constant and inevitable. Seeing both allows the patient to realize that their life can improve while helping them find a means to improve it.
The way change occurs with DBT is to change the balance of these forces. In Dialectical Behavior Therapy, not only does a small win allow a patient’s life to improve, but also means it will continue to get better. Finally, they believe that the opposites can be averaged out to find a better approximation of the truth. That means they can learn their life isn’t as bad as it may feel with their mood swings. Really, their life is the average of their violent mood swings.
Together, these aspects of dialectics mean DBT is an effective method for treating BPD. It has helped even some of the most difficult, “unstable”, and self-destructive patients regulate their emotions and find motivation for change.


The goals of dialectical behavior therapy are:
  • Help the patient become and stay motivated to change their life
  • Eliminate environmental factors that stimulate substance abuse
  • Use mindfulness training to teach patients to manage their moods
  • Reduce the need for drugs or alcohol
  • Helping the patient achieve their goals, no matter how small (e.g., staying sober for a complete day)
  • Provide connections to others through meaningful and self-affirming activities

Though DBT is the most effective treatment for BDP and substance abuse,  relapse is still common. Being prepared by knowing the signs of relapse can be helpful. There are even helpful ways to understand how relapse prevention works in scenarios with BPD and addiction treatment. 

There are No Approved Medications for BPD

Though there are medications to help with many of the symptoms of borderline personality disorder, there are medications that have been shown to control symptoms, such as antidepressants.
This means that treating both BDP and substance abuse simultaneously through dialectical behavior therapy is extremely important. Having a team of caring professionals to work one-on-one with during the treatment process can quite possibly save a life.

Addiction and Mental Illness in California 

It can be common for an individual struggling to fight an addiction to feel like a “failure” because they can’t keep up with sobriety. But what some people may not even be aware of is that one reason they find drugs or alcohol so appealing is because there’s an underlying issue. A mental health issue– such as depression, anxiety disorders, or personality disorders– may be present. 

How Common is Dual Diagnosis?

Nearly  8 million people in America have some kind of dual diagnosis– Half of which are men. It’s not known how many people go through life with an undiagnosed mental disorder, but it’s not unusual for someone in an addiction recovery program to realize they have a mental illness diagnosis through therapy and professional support.
Ironically, a large number of people who experience mental health issues can turn to substances early on as a way to cope with their difficult feelings. Whether someone is aware of it or not, their mental disorder could be a huge setback in their personal lives. From depression or anxiety to mood disorders or PTSD (Post-Traumatic Stress Disorder), mental illness can affect all aspects of our lives.

If left unaddressed, the effects of a dual diagnosis can lead to dependency on drugs or alcohol to cope with the pain. So many people use drugs to mask the pain and confusion of mental illness. When we use coping methods like this, it gradually leads to dependency or addiction. 

borderline personality disorder

What Dual Diagnosis Treatment Centers in California Offer

Finding an addiction treatment center that specializes in dual diagnosis can benefit you greatly in recovery. With professionals in therapy and treatment, the combined focus of both treatment options helps the whole person, not just aiming to focus on one thing like sobriety.

Each dual diagnosis treatment center should have an individualized approach, which means the treatment is geared toward the individual and what they need. Everyone’s dual diagnoses are different, and so is every addiction. With evidence-based treatment methods, good rehab centers with the dual diagnosis program approach can be beneficial to the whole person.

Depending on the severity of the substance abuse and mental illness, after a series of treatments the individual can safely start to live drug-free. From there, underlying mental or medical issues can be treated throughout the person’s remaining recovery, or sometimes the rest of their lives.


Therapies for Dual Diagnosis

There are many types of therapy for treating dual diagnoses. These include: 

  • Individual therapy
  • Family therapy
  • Trauma recovery therapy
  • EMDR Therapy
  • Cognitive Behavioral Therapy 

A successful treatment for dual diagnosis includes therapy for both mental and substance abuse. One or the other often will not lead to a full recovery. This is why many people who only focus on one or the other find themselves falling back into addiction. 

Dual Diagnosis Treatment Programs in California 

There are many places in California that serve patients with dual diagnoses. The first step is to define what addiction is present as well as any other mental illnesses. From there, a treatment plan can be put in place to treat the patient holistically (the whole person instead of just one or a few parts).
Often, Medication-Assisted Treatment will be utilized. This is when medications are prescribed by a psychiatrist to help establish a chemical balance within the brain after long-term drug use. 

Treatment options also include lifestyle support such as: 


It’s important to remember that even though dual diagnosis seems like an impossible struggle to overcome, there is tons of help out there. Recovery is possible, even when mental setbacks may be involved. The more support a person gets the better. Recovery is something nobody can do alone.

At Opus Health we’ve seen firsthand what dual diagnosis is like and many of our staff understands how important it is to receive individualized care through this treatment process. Our approach is a trusted, evidence-based modality including community and professional care.

Getting Help for BPD and Addiction

Having BPD or even BPD with substance abuse is not the end of the world. As a matter of fact, far from it. With proper care and treatment, BDP and substance abuse can be overcome. As with all mental illnesses, the most important step is the first one: asking for help.

Contact us at  Opus Health today if you need help finding treatment for bipolar personality disorder and addiction:


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