Borderline Personality Disorder Further Complicated by Substance Abuse

Comorbidity is a term describing two illnesses or conditions that are present together. One problem does not necessarily cause the other, but they appear in tandem often enough that they are considered medically linked. For the person with borderline personality disorder (BPD), substance abuse is often a comorbid problem.

According to the National Institutes on Mental Health, around 1.6 percent of American adults suffer with BPD. The condition typically shows up in young adulthood and is characterized by a chronic pattern of turbulent relationships, unstable mood and fluctuating self-image. A report by the National Alliance on Mental Illness says two out of every three people with BPD also struggle with substance abuse.

Substance Misuse Complicates the Problem

Misuse of tobacco, alcohol, prescription medications or illicit drugs is one of the reasons that BPD treatment can be so thorny. Using substances does temporarily blunt the pain of emotional struggles which plague those with this illness but, in reality, it also makes emotional upset even more likely. Though numbness due to substance use wears off rather quickly, the fallout of poor decisions and impulsive behaviors caused by substance abuse remain.

Problematic substance use tends to fall into one of two categories: substance dependence or substance abuse. Both categories represent unhealthy relationships to substances, but abuse defines a level of substance use with even greater negative consequences.


The person who is dependent on substances will use more and more over time because the body becomes tolerant, and more is needed in order to reach the desired effect. One glass of alcohol may have relaxed them initially, but now they need two glasses, soon they will need three and so on.

Another symptom of dependency is the amount of time and effort spent getting, using the substance or getting over the consequences of using the substance. In other words, the substance occupies a significant role in the persons’ life and thinking.

Because the substance becomes central to the individual’s life, social activities that are not focused on substance use tend to get phased out. Furthermore, the person will continue using the substance despite negative psychological or physical consequences.


Substance abuse includes all of the above and more. At this level, the person’s use of the substance interferes with their ability to perform at work or meet other important life responsibilities. They often start to have legal problems connected to their use. It could be a DUI, or they may start stealing in order to pay for the substance, but use has reached such a level that it leads to criminal behavior.

Substance abuse always winds up interfering with relationships. Using the substance is more important than caring for people or being honest with people. Not only do relationships suffer, but substance abuse often means that the person will continue to use despite obvious physical dangers as well.

The Impact on BPD

So what does all this mean for the person with BPD? To begin with, abusing substances will cause the symptoms of the illness to worsen dramatically. At the same time, the medications used to treat the disorder will become less effective due to the abuse. And, ironically, the craving for the substance will continue and grow driven by the stresses of worsening illness.

Because there is such a high comorbidity for substance abuse, patients with BPD should always be advised away from using substances like alcohol or any drugs other than those prescribed to them by a doctor. When substance abuse is already present, therapy for BPD should be augmented by participation in a proven 12 Step program like AA or NA. Without substance abuse treatment, there is little prospect of forward progress in treating the symptoms of BPD itself.