Borderline personality disorder (BPD) and substance misuse often go hand in hand. If you or someone you know is struggling with both, it can feel confusing and overwhelming. But you’re not alone, and understanding how these two issues connect can be a big help.
This article will explain what BPD is, why substance misuse happens alongside it, and how to get support.
Table of Contents:
What is substance misuse?
Substance misuse means using drugs or alcohol in a way that harms your health, relationships or daily life. It can include:
- Drinking too much alcohol
- Taking illegal drugs
- Misusing prescription medications
Substance misuse can start as a way to cope with stress, pain or difficult feelings. Over time, it can become a serious problem that affects your wellbeing and safety.
The relationship between BPD and substance misuse
Many people with BPD also struggle with substance misuse. This is called a co-occurring disorder or dual diagnosis. But why does this happen so often?
Coping with intense emotions
One of the biggest reasons is that substances can temporarily ease the intense emotions people with BPD feel. When feelings of anxiety, sadness or anger become too much, drugs or alcohol might seem like a quick way to feel better or numb those feelings.
Impulsivity and risk-taking
People with BPD often act impulsively, especially when upset. This can include risky behaviours like binge drinking, drug use or unsafe sex. These actions might provide short-term relief but can cause harm in the long run.
Difficult relationships and loneliness
BPD can make it hard to keep steady relationships. Feeling isolated or rejected may lead some people to use substances to fill that emotional gap or to escape loneliness.
Trauma and past experiences
Many people with BPD have a history of trauma, abuse or neglect. Substance misuse can sometimes be a way to cope with painful memories or ongoing distress.
How substance misuse affects BPD symptoms
Using drugs or alcohol when you have BPD can make symptoms worse, not better.
Increased emotional instability
Substances can heighten mood swings and make emotional control even harder. This can lead to more frequent or severe outbursts of anger, anxiety or depression.
Poor decision-making
Substance use lowers inhibitions, which can increase impulsive and risky behaviours. This might lead to self-harm, unsafe sex, or legal problems.
Relationship difficulties
Being under the influence or struggling with addiction can strain relationships further, leading to more conflict or isolation.
Interference with treatment
Substance misuse can make therapy or medication less effective. It can also make it harder to attend appointments or follow treatment plans.
Signs of substance misuse
It’s not always easy to tell if someone is struggling with substance misuse. Here are some signs to watch out for:
- Changes in behaviour or mood
- Neglecting responsibilities or hobbies
- Secretive or dishonest about activities
- Physical signs like bloodshot eyes or weight changes
- Financial problems or borrowing money often
- Increased arguments or withdrawal from loved ones
If you notice these signs, it’s important to approach the person with care and understanding, not judgement.
How to support someone with BPD and substance misuse
Supporting someone with both BPD and substance misuse can feel tough, but your care really matters.
Listen without judgement
People struggling with these issues often feel misunderstood. Listening openly and kindly can help them feel safe and less alone.
Encourage professional help
Suggest they speak to a doctor, therapist or addiction specialist. Many services now offer support tailored to co-occurring disorders.
Learn about their condition
Understanding BPD and addiction helps you offer better support and patience during hard times.
Set healthy boundaries
It’s okay to protect your own wellbeing. Setting clear limits helps maintain healthy relationships.
Treatment options for BPD and substance misuse
Treatment that addresses both BPD and substance misuse together is usually the most effective.
Dialectical behaviour therapy (DBT)
DBT is a type of therapy designed specifically for BPD. It teaches skills to manage emotions, reduce self-harm and improve relationships. DBT can also help with addiction triggers and cravings.
Integrated treatment programmes
Some clinics offer combined treatment for BPD and substance misuse, including counselling, medication and peer support.
Medication
While there’s no medicine to cure BPD, some medications can help with mood swings, anxiety or depression. Addiction treatment may also include medications to manage withdrawal or cravings.
Support groups
Groups like Alcoholics Anonymous or mental health peer support can provide connection and encouragement from others who understand.
Self-help tips for managing BPD and substance misuse
Alongside professional help, there are things you can do yourself to feel better and reduce substance misuse.
Develop coping skills
Try techniques like deep breathing, mindfulness or journaling to manage tough emotions without turning to substances.
Create a routine
Having a daily routine can bring structure and reduce impulsive behaviour.
Stay connected
Reach out to friends, family or support groups to avoid isolation.
Avoid triggers
Identify people, places or feelings that make you want to use substances and plan ways to cope or avoid them.
Practice self-compassion
Be kind to yourself. Recovery is a journey with ups and downs.
Myths and facts about BPD and addiction
There are many misunderstandings about BPD and addiction. Here are some common myths debunked:
- Myth: People with BPD just want attention.
Fact: BPD causes real emotional pain and difficulties, not just attention-seeking. - Myth: Substance misuse means weak willpower.
Fact: Addiction is a complex health issue, not a choice or weakness. - Myth: People with BPD can’t recover.
Fact: Many people with BPD live full, meaningful lives with the right support.
Helpful resources
If you or someone you know is struggling with substance misuse, these UK charities and organisations can offer advice, support and treatment options:
- With You
wearewithyou.org.uk
Free and confidential support for drug and alcohol problems, including one-to-one advice and treatment programmes. - Alcohol Change UK
alcoholchange.org.uk
Resources and support to help reduce or stop drinking alcohol, plus information on treatment options. - FRANK
talktofrank.com
Free, confidential drug and alcohol advice with a 24/7 helpline and online chat service. - Addaction (part of With You)
Support for people dealing with substance misuse and mental health issues, with tailored recovery programmes. - Narcotics Anonymous UK
ukna.org
Peer support groups for people recovering from drug addiction. - SMART Recovery UK
smartrecovery.org.uk
Science-based support groups to help overcome addiction. - Mind
mind.org.uk
Mental health support and information, including help for co-occurring substance misuse and mental health problems.
Final thoughts: BPD and substance misuse
Borderline personality disorder and substance misuse can feel like a tough combination, but understanding how they relate helps take away some of the fear and confusion. Recovery is possible, and help is available. Whether you’re living with these challenges or supporting someone who is, taking small steps to learn, connect and seek support can make a big difference.
If you or someone you care about is struggling with BPD and substance misuse, remember you’re not alone. There are people and services ready to help you find a healthier, happier path.
