Medical Reviewer

BPD and Addiction: What You Should Know

Last Medical Review On: July 17, 2024
Updated On: June 15, 2024
7 min read
Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po-Chang Hsu, M.D., M.S.

Borderline personality disorder (BPD) and addiction often intersect, creating complex challenges for people struggling with both conditions.[1] BPD is characterized by intense emotions, unstable relationships, and impulsive behaviors, while addiction involves a compulsive dependence on substances or behaviors despite suffering negative consequences.

Understanding the relationship between BPD and addiction is critical for accessing effective treatment and support.[2] Learning more about these two conditions can help you seek the support you need to recover.

BPD and Addiction

Key Points

  • BPD is characterized by intense emotions, unstable relationships, and impulsive behaviors, while addiction involves a compulsive dependence on substances or behaviors despite negative consequences.
  • BPD and addiction are often interconnected due to shared vulnerabilities and coping mechanisms.
  • Signs of BPD individuals struggling with addiction include frequent substance use, changes in behavior, and engagement in risky behaviors.
  • Specialized treatment programs exist for individuals with both BPD and addiction, offering integrated approaches such as dialectical behavior therapy (DBT) and substance abuse counseling.
  • Dual-diagnosis addiction treatment involves comprehensive assessments, personalized treatment plans, therapy, medication management, holistic therapies, and aftercare planning to support long-term recovery.
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    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 0.7 to 2.7% of the general population exhibits symptoms indicative of BPD at any given point in time.[5]

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    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 use 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 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 without some of these risk factors may still develop addiction. 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 to promote recovery and improve overall well-being. Depending on the severity of substance use, medical detoxification may be necessary to manage withdrawal symptoms and stabilize physical health safely.

    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.

    Aftercare planning is often important to support sustained recovery upon completing the primary treatment program. 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 manage the physical symptoms of withdrawal safely. 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. This holistic approach fosters comprehensive healing and promotes long-term well-being by addressing patients’ physical and psychological aspects of their conditions.
    • 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. Patients participate in various therapeutic activities during inpatient rehab, 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 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 individual sessions, group training, coaching, and assignments to equip individuals with coping mechanisms and foster emotional stability throughout the treatment process.
    • Motivational Interviewing (MI) is a counseling approach focused on enhancing motivation for behavior change. Therapists engage in collaborative conversations, demonstrate empathy, and employ reflective listening techniques to help individuals align their behavior with their desired goals. MI empowers individuals by reinforcing their readiness and commitment to making substantial life changes.
    • 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 can express emotions and develop coping skills within a nurturing environment encompassing 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 manage them effectively. 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). These programs cultivate community and accountability through group meetings, step work, and peer support. Active engagement in these programs empowers individuals to establish and sustain sobriety while acquiring essential tools for long-term recovery.

    Among the many addiction treatment centers, Maryland‘s Alpas Wellness offers a unique blend of traditional and holistic therapies. Our team of specialists utilizes state-of-the-art therapeutic methods to assist you in achieving a healthier, drug-free lifestyle.

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    Frequently Asked Questions about BPD Addiction and Treatment


    How does addiction impact mental health?


    Addiction can exacerbate existing mental health issues and contribute to the development of new ones. Substance abuse can lead to symptoms of depression, anxiety, paranoia, and psychosis. Additionally, addiction often impairs cognitive function, decision-making abilities, and emotional regulation, further impacting mental health.


    What are the signs that someone with BPD may be struggling with addiction?


    Signs that someone with BPD may be struggling with addiction include frequent substance use, unsuccessful attempts to cut down or quit, neglect of responsibilities, changes in behavior or mood swings, and engaging in risky behaviors while under the influence. Additionally, individuals with BPD may use substances to cope with intense emotions or to numb emotional pain.


    Are there specialized treatment programs for individuals with BPD and addiction?


    Yes, there are specialized treatment programs that address the unique needs of individuals with both BPD and addiction. These programs typically offer integrated approaches that simultaneously target both disorders, incorporating therapies such as dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and substance abuse counseling. Treatment may be provided in various inpatient, outpatient, or residential settings.


    How can friends and family members support a loved one struggling with BPD and addiction?


    Family members can support a loved one with BPD and addiction by educating themselves about both conditions, practicing empathy and understanding, maintaining open communication, and providing emotional support without enabling destructive behaviors. Encouraging treatment-seeking behavior, attending therapy sessions, and establishing healthy boundaries are crucial in supporting recovery.


    What lifestyle changes can help individuals with BPD and addiction maintain sobriety?


    Lifestyle changes that can help individuals with BPD and addiction maintain sobriety include adopting healthy coping mechanisms, such as mindfulness practices, exercise, and hobbies, to manage stress and regulate emotions. Building a strong support network, avoiding triggers, attending support groups, and seeking professional help when needed are also essential. Creating a structured routine, prioritizing self-care, and avoiding high-risk situations can also contribute to long-term recovery.


    [1] Shen, C.-C., Hu, L.-Y., & Hu, Y.-H. (2017). Comorbidity study of borderline personality disorder: applying association rule mining to the Taiwan national health insurance research database. BMC Medical Informatics and Decision Making, 17(8).

    [2] SAMHSA. (2023, July 26). Co-Occurring disorders and other health conditions.

    [3] Borderline Personality Disorder. (2023, February 8).

    [4] Klein, P., Fairweather, A. K., & Lawn, S. (2022). Structural stigma and its impact on healthcare for Borderline Personality disorder: A scoping review. International Journal of Mental Health Systems, 16(1).

    [5] Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline personality disorder. National Library of Medicine; StatPearls Publishing.

    [6] Kienast, T., Stoffers, J., Bermpohl, F., & Lieb, K. (2014). Borderline Personality Disorder and Comorbid Addiction. Deutsches Aerzteblatt Online, 111(16).

    [7] National Institute of Mental Health. (2023, April). Borderline Personality Disorder. National Institute of Mental Health.

    [8] NIDA. (2018, June 6). Understanding Drug Use and Addiction Drug Facts. National Institute on Drug Abuse; National Institute of Health.

    [9] National Institute on Drug Abuse. (2020, April). What are the treatments for comorbid substance use disorder and mental health conditions? National Institute on Drug Abuse.

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