BPD and Addiction: What You Should Know

What Is BPD?

Borderline personality disorder, or BPD, is a mental health condition characterized by pervasive patterns of instability in mood, self-image, and interpersonal relationships.[3] Individuals with BPD often experience intense emotional swings, have difficulties regulating their emotions, and struggle with a fragile sense of self.

While everyone may encounter occasional mood fluctuations, those with BPD face persistent and extreme emotional turmoil that significantly impacts their daily functioning and relationships. BPD is often misunderstood or mischaracterized, leading to stigma and barriers to effective treatment.[4]

It has been estimated that approximately 1.6% of the general population exhibits symptoms indicative of BPD at any given point in time, with a lifetime prevalence of this disorder estimated to be around 5.9%.[5]

How Are BPD and Addiction Related?

BPD and addiction are often interconnected due to several underlying factors. Individuals with BPD may turn to substances or addictive behaviors as a way to manage overwhelming emotions, alleviate distress, or numb emotional pain.[6] The impulsivity and emotional dysregulation characteristic of BPD can increase the risk of engaging in substance abuse or addictive behaviors as a maladaptive coping strategy.

Additionally, substance abuse or addiction can exacerbate symptoms of BPD, leading to a cycle of worsening emotional instability and dysfunctional behaviors. The presence of both BPD and addiction can complicate treatment efforts, as addressing one without considering the other may be ineffective in achieving lasting recovery and stability.

What are the Risk Factors for Developing BPD?

Several factors can contribute to the development of BPD, including:[7]

• Genetics: There is evidence to suggest that BPD may have a genetic component, as individuals with a family history of BPD or other mood disorders are at an increased risk of developing the condition.
• Childhood trauma: Experiencing neglect, abuse, or other traumatic events during childhood can significantly increase the likelihood of developing BPD later in life. Traumatic experiences may disrupt the development of healthy coping mechanisms and contribute to emotional dysregulation.
• Environmental factors: Environmental factors such as unstable family dynamics, inconsistent caregiving, or exposure to substance abuse can contribute to the development of BPD. These factors may shape interpersonal relationships and impact emotional regulation skills.
• Neurobiological factors: Differences in brain structure and function, particularly in areas involved in emotional regulation and impulse control, may predispose individuals to BPD. Imbalances in neurotransmitters, such as serotonin and dopamine, have also been implicated in the development of the disorder.
• Temperamental factors: Certain personality traits, such as high sensitivity to emotional stimuli, impulsivity, and difficulty with frustration tolerance, may increase the risk of developing BPD. These traits may interact with environmental factors to contribute to the onset of the disorder.
• Other co-occurring mental health conditions: BPD often co-occurs with other mental health disorders, such as depression, anxiety, or substance use disorders. The presence of these comorbid conditions can exacerbate symptoms and contribute to the development or worsening of BPD.

While these risk factors may increase the likelihood of developing BPD, it’s important to note that not everyone with these risk factors will develop the disorder, and individuals without these risk factors may still develop BPD. Additionally, the interaction between genetic, environmental, and biological factors in the development of BPD is complex and not fully understood.

What are the Risk Factors for BPD Addiction?

Similarly, several risk factors can contribute to the development of addiction—many of which overlap with BPD:[8]

• Genetics: Genetic factors play a significant role in susceptibility to addiction. Individuals with a family history of addiction are at a higher risk of developing addiction themselves due to genetic predispositions.
• Environmental factors: Environmental influences, such as exposure to substance abuse within the family or peer group, socioeconomic status, availability of substances, and cultural attitudes towards substance use, can increase the likelihood of developing addiction.
• Childhood trauma: Adverse childhood experiences, such as physical, emotional, or sexual abuse, neglect, or other forms of trauma, can increase the risk of addiction later in life. Trauma can lead to coping mechanisms involving substance use as a way to self-medicate or escape from distressing emotions.
• Dual diagnosis issues: Co-occurring mental health disorders, such as depression, anxiety, trauma-related disorders, or personality disorders like BPD, are common among individuals with addiction. These mental health conditions may increase vulnerability to substance abuse as individuals may use substances to alleviate symptoms or self-medicate.
• Peer influence: Peer pressure and social norms surrounding substance use can influence an individual’s likelihood of experimenting with or developing addiction. Associating with peers who engage in substance use can increase the risk of substance abuse.
• Substance use at an early age: Initiation of substance use at a young age, particularly during adolescence when the brain is still developing, can increase the risk of addiction. Early exposure to substances may alter brain chemistry and increase susceptibility to developing addictive behaviors.
• Stress: Chronic stress, life transitions, and traumatic events can trigger or exacerbate substance abuse as individuals may turn to substances as a way to cope with difficult emotions or situations.
• Neurobiological factors: Neurobiological differences in brain structure and function, including alterations in neurotransmitter systems (e.g., dopamine, serotonin), reward circuitry, and impulse control, can contribute to addiction vulnerability.

Much like BPD, it’s important to note that the presence of risk factors does not guarantee the development of addiction, and individuals may develop addiction in the absence of some of these risk factors. Additionally, protective factors, such as strong social support, healthy coping mechanisms, and access to mental health treatment, can mitigate the impact of risk factors and reduce the likelihood of addiction.

Co-Occurring Disorder Treatment

Dual-diagnosis addiction treatment encompasses a holistic approach designed to address the complex needs of individuals facing both substance use disorders and co-occurring mental health conditions such as BPD.[9] Comprehensive assessments are conducted to evaluate your specific needs.

Following assessment, a personalized treatment plan is developed, tailored to address the unique challenges of both addiction and the co-occurring mental health disorder(s). This plan outlines goals, interventions, and modalities aimed at promoting recovery and improving overall well-being. Depending on the severity of substance use, medical detoxification may be necessary to safely manage withdrawal symptoms and stabilize physical health.

Therapy and counseling are central components of dual diagnosis treatment, offering opportunities for individuals to explore underlying issues, develop coping skills, and improve emotional regulation. Individual, group, and family therapy sessions provide support and guidance while fostering relapse-prevention strategies. Additionally, medication management may be incorporated to address psychiatric symptoms, reduce cravings, and support long-term recovery.

Upon completion of the primary treatment program, aftercare planning is often important to support sustained recovery. This may involve referrals to community resources, outpatient therapy, support groups, and continued psychiatric care. By offering integrated care that addresses both addiction and co-occurring mental health disorders, dual-diagnosis treatment aims to empower individuals to achieve lasting recovery and improve their overall quality of life.

BPD Addiction Treatment Levels of Care

No two treatment plans are the same—which is why co-occurring treatment centers usually offer several different levels of care for your unique needs:

• Medical Detoxification (Detox): Detoxification, commonly referred to as detox, is the deliberate process of eliminating harmful substances such as drugs or alcohol from the body. Typically conducted under close supervision in medical facilities or specialized detox centers, the primary aim of detox is to safely manage the physical symptoms of withdrawal. This preparatory phase helps individuals transition smoothly into subsequent stages of treatment and rehabilitation.
• Medically Managed Care: Medically managed care integrates medical expertise with therapy to provide comprehensive support to patients during their recovery journey. This level of care involves vigilant monitoring by medical professionals who customize treatments and collaborate with other team members. By addressing both the physical and psychological aspects of patients’ conditions, this holistic approach fosters comprehensive healing and promotes long-term well-being.
• Inpatient Residential Treatment: Inpatient treatment, also known as residential treatment, refers to a level of care where individuals reside in a facility for the duration of their treatment program. Inpatient treatment is typically recommended for individuals with severe addiction or mental health issues that require intensive, round-the-clock care and supervision. During inpatient rehab, patients participate in various therapeutic activities, including individual therapy, group therapy, educational sessions, and experiential therapies. Medical and psychiatric support is readily available, and the structured environment helps individuals focus solely on their recovery without distractions from the outside world. Inpatient treatment programs vary in length, with some lasting a few weeks to several months, depending on the individual’s needs and progress in treatment.

Therapies Used in BPD Addiction Treatment

Thankfully, Alpas offers many evidence-based approaches to treat co-occurring issues like BPD and addiction:

• Cognitive Behavioral Therapy (CBT): CBT is a highly regarded therapeutic approach widely utilized for addressing negative thought patterns and behaviors associated with mental health conditions, including borderline personality disorder and addiction. In collaborative sessions with a therapist, individuals are encouraged to challenge distorted thinking, learn coping strategies, and effectively manage cravings. This empowering method facilitates insight into thought processes and behavior patterns, empowering individuals to make positive changes and achieve sustainable recovery.
• Dialectical Behavior Therapy (DBT): DBT seamlessly integrates mindfulness, acceptance, and behavior change strategies within a cognitive-behavioral framework. Originally designed for BPD, DBT has broadened its scope to encompass various mental health challenges, including addiction. It prioritizes the development of skills in emotion regulation, interpersonal effectiveness, and distress tolerance. Therapists employ a blend of individual sessions, group training, coaching, and assignments to equip individuals with coping mechanisms and foster emotional stability throughout the treatment process.
• Motivational Interviewing (MI): MI is a counseling approach focused on enhancing motivation for behavior change. Therapists engage in collaborative conversations, demonstrating empathy and employing reflective listening techniques to help individuals align their behavior with their desired goals. MI aims to empower individuals by reinforcing their readiness and commitment to making substantial changes in their lives.
• Contingency Management: Contingency management is a therapeutic strategy that leverages rewards to incentivize desired behaviors, such as maintaining sobriety. Individuals are rewarded for achieving treatment goals, such as attending sessions or passing drug tests. These rewards, which may include vouchers or prizes, are intended to bolster motivation and promote adherence to treatment objectives.
• Motivational Enhancement Therapy (MET): Motivational Enhancement Therapy is a counseling approach focused on boosting motivation and commitment to behavior change. Through structured discussions and feedback, MET addresses ambivalence about changing behaviors by assisting individuals in clarifying their values and goals. By nurturing confidence in their capacity to change, MET emphasizes internal motivation for positive transformation rather than delving into the underlying causes of addiction.
• Experiential Therapy: Experiential therapy utilizes interactive activities to encourage emotional processing and foster personal growth. Diverging from conventional talk therapy, it incorporates hands-on approaches such as role-playing and art therapy. Through these activities, individuals have the opportunity to express emotions and develop coping skills within a nurturing environment that encompasses the body, mind, and spirit, facilitating profound personal transformation.
• Relapse Prevention: Relapse prevention is essential in the recovery process, aiding individuals in identifying triggers, building coping strategies, and devising plans to avoid relapse. In this therapy, participants gain insight into warning signs such as stress and emotional triggers, while acquiring skills to effectively manage them. By cultivating self-awareness and equipping individuals with practical tools, relapse prevention therapy addresses the underlying causes of addictive behaviors, thereby fostering sustained sobriety.
• Twelve-Step Facilitation: Twelve-step facilitation is a pivotal aspect of addiction recovery, involving individuals in programs such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Through group meetings, step work, and peer support, these programs cultivate a sense of community and accountability. Active engagement in these programs empowers individuals to establish and sustain sobriety while acquiring essential tools for long-term recovery.