November 9, 2023

Borderline Personality and Addiction Treatment Approaches

Grasping the complexity of the relationship between BPD and addiction is crucial, paving the way for treatment approaches that address the entangled roots of both, leading to more effective and sustained recovery outcomes.

borderline personality disorder and addiction

Table of Contents

Table of Contents

Contributors & Editors

Susana Spiegel

Recovery Writer and Advocate

Last Update on November 16, 2023

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What is the approach to treating Borderline Personality and addiction?

Borderline Personality Disorder (BPD) is a complex mental health condition marked by intense emotional instability and impulsive behaviors.

When addiction enters the mix, the struggle becomes deeply intertwined, as each condition can exacerbate the other’s symptoms.

Grasping the complexity of the relationship between BPD and addiction is crucial, paving the way for treatment approaches that address the entangled roots of both, leading to more effective and sustained recovery outcomes.

Neurological Insights into Addiction and BPD

The impact of drugs and alcohol on the brain is significant, especially in the context of BPD. 

Substance use alters brain pathways, creating associations between drug use and euphoria. 

This change can result in intense cravings and relapse risks, even after prolonged abstinence. 

Understanding the brain’s reward system is key to recognizing these challenges and the importance of vigilant, continuous therapy.

Therapeutic Strategies for BPD and Addiction

Treatment for BPD and addiction must be integrated and multifaceted. 

Cognitive Behavioral Therapy (CBT) is essential in helping individuals identify triggers and develop coping strategies. 

Medications like Naltrexone and antidepressants can also play a role in reducing cravings and stabilizing mood. 

It’s crucial to address both psychological and biological factors in treatment.

Understanding and Managing BPD

BPD involves pervasive mood instability, fear of abandonment, and impulsive behaviors, often leading to self-harm and risky actions. 

Recognizing the depth and variability of BPD symptoms is vital, especially when addiction is involved. 

Effective treatment must address these multifaceted challenges.

Understanding Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a personality disorder characterized by pervasive instability in moods, behavior, self-image, and functioning.

According to the National Institute of Mental Health (NIMH), individuals with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

People with BPD tend to struggle with fear of abandonment and will take extreme measures to avoid being abandoned by those they care about.

Common symptoms of BPD various seriously impact a person’s lifestyle.


Here are Common Symptoms of Borderline Personality Disorder


Emotional RegulationIntense and Highly Variable Moods, Chronic Feelings of Emptiness, or Intense Anger
Fears and BehaviorFear of Abandonment, Unstable Relationships
Self ImageDistorted Self-Image, Dissociation
ImpulsivityRisky Behaviors, Suicidal Threats or Behaviors, Self-harming behavior


Understanding BPD involves recognizing the depth and variability of these symptoms, significantly impacting the person’s life and well-being.

When addiction is entangled, it often acts as a maladaptive coping mechanism, further problematizing the emotional and behavioral challenges of BPD.

Effective treatment must address the multifaceted nature of BPD, including the additional layer of complexity that addiction introduces.

The Link Between BPD and Substance Abuse

The intersection of Borderline Personality Disorder (BPD) and substance abuse is alarmingly common, with a substantial number of individuals with BPD turning to drugs or alcohol.

According to Borderline In The Act, “Of all the personality disorders, BPD is typically the second most prevalent to have patients with substance abuse.

About 78% of adults with BPD develop a substance use disorder or addiction at some time in their lives.”

Unfortunately, substance abuse and BPD negatively complement each other.

This intersection stems from a complex interplay of psychological factors and the ingrained characteristics of BPD.

High Prevalence of Co-occurring BPD and Addiction
Research indicates that the prevalence of addiction among those with BPD is significantly higher than in the general population.

The reasons for this deepened vulnerability to substance abuse are multifaceted, involving emotional, behavioral, and psychological dimensions.

Reasons for Substance Use in BP
Individuals grappling with BPD live through deep depressions.

In the depths of emotional pain, extreme mood swings, and an enduring sense of emptiness, using drugs and alcohol can supply satisfaction and provide escapism. 

People with BPD may self-medicate with substances as a coping mechanism, an attempt to manage the intense emotional pain and mood instability that characterize the disorder.

Substances might temporarily quiet the emotions of rejection, failure, or abandonment, although with detrimental long-term consequences.

Impulsivity and Substance Use
Impulsivity is a core feature of BPD and is particularly relevant to substance abuse.

The tendency to act impulsively without thinking about the consequences can lead individuals with BPD to engage in substance use as a rash decision, further entangling the cycle of addiction.

The importance of understanding the entanglement of  BPD and addiction has to be recognized for these conditions to promote more effective interventions and support long-term recovery.

Treatment Approaches for Co-occurring BPD and Addiction

The importance of integrated care.

Evidence-based treatments such as Dialectical Behavior Therapy (DBT) and its relevance for this population.

Addressing both the emotional and behavioral aspects of the disorders.

The role of supportive therapy and family therapy.

Integrated CareA treatment approach that simultaneously addresses BPD and addiction.
Dialectical Behavior Therapy (DBT)A type of cognitive-behavioral therapy tailored to meet the specific needs of individuals with BPD, adaptable for treating substance abuse.
Emotional and Behavioral InterventionsTreatment strategies that focus on understanding and managing emotions along with modifying harmful behaviors.
Supportive and Family TherapySupportive therapy offers a validating space, while family therapy engages and educates family members to improve support systems.

Challenges in Treatment and Recovery

The coexistence of Borderline Personality Disorder (BPD) and substance abuse can create a complex treatment landscape, presenting unique challenges in both treatment and recovery

Difficulties in Achieving Sobriety with BPD Symptoms

The emotional toll and impulsivity of BPD inherents to can hinder the consistent and rational decision-making required for sobriety.

BPD symptoms like fear of abandonment can lead to seeking comfort in substances when faced with stressful interpersonal situations.

Potential Barriers to Treatment:


BPD itself is often misunderstood, which can lead to stigma not only from society but also from healthcare providers, potentially affecting the quality of care or the willingness of individuals to seek help.

Lack of Specialized Care

There is a shortage of treatment programs that specialize in handling both BPD and addiction, making access to appropriate care a significant barrier.

The Importance of a Tailored Approach

Patience and Persistence: Recovery is often non-linear, requiring providers and support systems to maintain patience and persistence despite possible setbacks.

Tailored Care

Treatment plans need to be personalize to each different individuals needs to be.

Just like everyone in addiction.

Though with this in particular taking into account the unique patterns of each person’s BPD and substance use is very cruical in each persons personal stragetgic foundation of recovery.

This often means integrating different therapeutic modalities and ensuring that care providers are well-versed in both BPD and addiction.

Understanding these challenges is crucial for healthcare providers, patients, and their support networks.

It allows for the creation of more effective, compassionate, and patient-centric approaches to treatment and long-term recovery.

Getting Help for BPD and Addiction

Understanding Borderline Personality Disorder entangled with addiction is incredibly important; it paints an entirely different picture.

Knowing the intensive care it takes to mend a stable foundation is essential and should be acknowledged.

If you find reflection in yourself or a loved one reading this article, please reach out today.

If you or someone you care about is facing addiction or mental health challenges, we encourage you to contact us.

Cornerstone Healing Center is a rehab in Arizona that treats Borderline Personality Disorder and Addiction. 

Our treatment facility is grounded in evidence-based practices and specializes in dual diagnosis, promoting long-term recovery by addressing underlying issues.

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Author & Reviewers

susana spiegel recovery writer and SEO expert

Susana is a recovery writer and advocate with over 8 years in addiction recovery. She is passionate about sharing accurate and helpful information about mental health, addiction, and recovery. She holds a Bachelor’s in Christian Studies from Grand Canyon University and has over 7 years of working in the addiction field. 

lionel estrada lisac clinical director

Lionel is the Clinical Director of Cornerstone’s Scottsdale treatment facilities. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges; he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues.

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