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Borderline Personality Disorder
Comprehensive Treatment for Borderline Personality Disorder and Substance Abuse
People who live with Borderline Personality Disorder (BPD) commonly have a stronger emotional response to experiences compared to other people. They may also find it difficult to manage these feelings once they develop. While symptoms of BPD vary from person to person, the condition is often associated with considerable distress in various aspects of their lives. This stress can be felt in the relationships they form or maintain, in how they make decisions, in their sense of self-worth, and in their overall daily functioning.
Because substance use disorders frequently occur alongside BPD, Agape Detox Center provides integrated dual diagnosis treatment that addresses both conditions through coordinated psychiatric, therapeutic, and addiction-focused care.
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a serious mental illness that is defined by instability in emotions, self-image, relationship patterns, and behavior.[1] Defined as a personality disorder by the Diagnostic Statistical Manual Fifth Edition (DSM-5), BPD affects between 1.6% to 5.9% of adults in the US.[2] Those in addiction treatment and inpatient psychiatric facilities have substantially greater rates of BPD than the general population.[3]
People with BPD suffer from extreme emotional dysregulation, an inability to moderate intense emotional reactions that others would naturally and automatically manage. This emotional sensitivity, in combination with impulsiveness and a fragile sense of identity, creates a pattern of relationships and behavior that is chaotic, self-destructive, and deeply distressing to the person experiencing them.[4]
Borderline personality disorder is frequently underrecognized or misdiagnosed because its symptoms overlap with conditions such as bipolar disorder, PTSD, depression, and anxiety disorders.[5]
Signs and Symptoms of BPD
According to the DSM-5, a BPD diagnosis requires a person to exhibit five or more of the following characteristics:[6]
- Frantic efforts to prevent actual or perceived abandonment
- Unstable and intense interpersonal relationships that alternate between idealization and devaluation
- Identity disturbance — markedly unstable sense of self or identity
- Impulsive and self-damaging behavior in at least two areas, such as drug and alcohol use, spending, sex, or reckless driving
- Repeated suicidal behavior, gestures, threats, or self-harm
- Emotional instability and mood swings, intense episodes of dysphoria, irritability, or anxiety lasting several hours to days
- Chronic feelings of emptiness
- Irritability, inappropriate anger, or recurrent explosive outbursts
- Transient, stress-related paranoia or severe dissociative symptoms
BPD and Substance Abuse: The Co-Occurring Connection
Research indicates that there is a significant correlation between BPD and substance use. Evidence consistently shows that people suffering from BPD have an unusually high rate of developing substance use disorders — including alcohol use disorder, opioid dependence, and other types of substance-related disorders — compared to the overall population, with some studies suggesting that nearly 80% of people diagnosed with BPD will develop a substance use disorder at some point during their lives.[7]
There are multiple interconnected avenues that explain this. One major factor is impulsivity. Impulsivity is one of the key features of BPD and is considered to be a major risk factor for the development of addiction.[8] For people with BPD, the same impulse control deficits that drive reckless behavior, unstable relationships, and self-harming behavior also make substance use more likely.[9]
Another fundamental connection is self-medication.[10] The emotional dysregulation that is characteristic of BPD can be internally overwhelming, and those with BPD naturally seek ways to alleviate this. Substances are a convenient means of temporarily doing so. Alcohol numbs the acute pain of abandonment or rejection. Opioids quiet the chronic feelings of emptiness. The self-medication pattern in BPD is not weakness; it is a rational response to emotional pain that has outpaced a person’s coping capacity.
Drugs and alcohol, in turn, worsen BPD, increasing emotional dysregulation, deteriorating interpersonal relationships, elevating risk for self-destructive behaviors and suicidal attempts, and perpetuating a cycle in a way that requires integrated treatment in order to fully address.[11]
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When to Get Help
Signs you might need dual diagnosis treatment for BPD and substance use disorder include:
- Using alcohol or drugs as a way to regulate intense feelings of emptiness or interpersonal distress
- Impulsive substance use when experiencing emotional crises or as a result of perceived abandonment
- Self-harm behaviors or suicidal ideation while using substances
- Past experiences with addiction treatments that did not acknowledge the underlying emotional dysregulation issues that contributed to drug or alcohol use
- Previous experiences with BPD treatment that failed to take into consideration the presence of co-occurring substance use
- Interpersonal relationships and daily life is significantly impaired due to the interplay between both disorders
BPD Treatment at Agape Detox
Agape Detox offers treatment for borderline personality disorder (BPD) through our comprehensive dual diagnosis program — treating both borderline personality disorder and co-occurring substance use simultaneously. At Agape Detox Center, every client receives care from a multidisciplinary team of clinicians trained in the treatment of personality disorders.
All new admissions complete a comprehensive mental health and psychological assessment upon admission. Those that we suspect or identify as having BPD also receive assessments of symptom levels, self-harm and suicide risk, history of trauma, and the extent to which BPD is contributing to the client’s current substance use. These results help us develop the individualized treatment plans that will guide each client’s overall care.
Dialectical Behavior Therapy (DBT)
Developed by Dr. Marsha Linehan — who openly discusses her own struggles with BPD — Dialectical Behavior Therapy (DBT) is considered the gold standard evidence-based treatment for borderline personality disorder.[12]
DBT was developed specifically for people who experience intense emotions. It teaches skills across four areas of function that directly treat both BPD and its relationship with substance use:
- Emotional regulation — Learning to understand and manage extreme emotional responses so they do not control you
- Distress tolerance — Developing ways to survive emotional crises without worsening the situation or escaping through substance use
- Interpersonal effectiveness — Finding ways to navigate relationships more effectively, reducing the chaotic nature of unstable relationships that are characteristic of BPD
- Mindfulness — Establishing greater awareness of one’s immediate circumstances that creates space between emotional triggers and impulsive reactions
Additional Evidence-Based Therapies
In addition to BPD, we also offer other types of evidence-based therapy that may be used during your treatment, including cognitive behavioral therapy (CBT), individual therapy, group therapy, family therapy, and others.
Medication Management
There is currently no FDA-approved medication to treat BPD. However, psychiatric medications are commonly used to treat various symptoms, such as mood stabilizers for emotional dysregulation, antidepressant medications for depression and chronic emptiness, and low doses of antipsychotic medications for dissociative episodes or paranoia.[13] Our psychiatry team manages medications cautiously within the context of co-occurring addiction treatment.
Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.
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FAQ
Frequently Asked Questions About BPD and Substance Abuse
Why do BPD and substance abuse co-occur so frequently?
People with BPD have far greater rates of substance use disorder than the general population — many studies report a lifetime prevalence of over 60%. People with BPD tend to be impulsive and seek substances as a form of self-medication for their emotional dysregulation. These two disorders require integrated dual diagnosis treatment.
What is DBT and why is it used for BPD?
Dialectical Behavior Therapy (DBT), which was originally developed for treating people who experience extreme intensity in their emotions and find other forms of therapy ineffective, is widely regarded as the most successful intervention for BPD. DBT helps develop a person’s ability to regulate their emotions, tolerate distress, manage interpersonal interactions effectively, and develop a sense of awareness through mindfulness — all of which address the core characteristics of BPD and the emotional triggers of substance use.
Can BPD and addiction be treated at the same time?
Yes. Coordinated dual diagnosis treatment is the preferred method of treatment. When one disorder is treated without regard to the presence of another, a significant portion of the original disorder remains untreated. All members of the clinical staff at Agape work together from day one to provide simultaneous treatment for both disorders.
Is BPD the same as bipolar disorder?
No. BPD and bipolar disorder are distinct conditions that share some surface similarities. Both involve mood instability but differ significantly in their underlying mechanisms, presentation, and treatment approach. BPD mood shifts are typically triggered by interpersonal events and last hours, while bipolar episodes are more autonomous and last days to weeks. Accurate diagnosis is essential for effective treatment.
Sources
[1] [2] National Institute of Mental Health. (n.d.). Borderline personality disorder. https://www.nimh.nih.gov/health/publications/borderline-personality-disorder
[3] [7] [10] [11] Substance Abuse and Mental Health Services Administration. (2014). Substance use disorders and borderline personality disorder. https://library.samhsa.gov/sites/default/files/sma14-4879.pdf
[4] [8] [9] Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510. https://pmc.ncbi.nlm.nih.gov/articles/PMC2696274/
[5] [13] Zimmerman, M. (2026). Borderline personality disorder (BPD). MSD Manual Professional Edition.https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/borderline-personality-disorder-bpd
[6] American Academy of Family Physicians. (2022). Borderline personality disorder. https://www.aafp.org/pubs/afp/issues/2022/0200/p156.html
[12] Stoffers, J. M., et al. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, (8), CD005652. https://doi.org/10.1002/14651858.CD005652.pub2