Dual Diagnosis Treatment: Borderline Personality Disorder and Addiction


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 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 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.

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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