Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Borderline personality disorder (BPD) is a mental health condition marked by intense, fast-changing emotions, unstable relationships, a shifting sense of self and impulsive behavior. People with BPD often feel emotions more deeply and for longer than others, and ordinary setbacks can feel devastating. It is also a condition that frequently travels with substance use, as alcohol or drugs become a way to survive emotional storms.
This article explores why BPD and addiction so often occur together, how each makes the other harder, and what effective treatment looks like. Self-harm and suicidal thoughts are common with BPD. If you have urges to hurt yourself or thoughts of ending your life, call or text 988 now. If you have already harmed yourself or anyone is in immediate danger, call 911.
What Is Borderline Personality Disorder?
BPD affects how a person feels about themselves, relates to others and manages emotions. Common signs include:
- Intense fear of abandonment and frantic efforts to avoid it, real or imagined
- Relationships that swing between idealizing someone and feeling betrayed by them
- An unstable self-image, with goals, values or identity that change quickly
- Impulsive, risky behavior such as reckless spending, unsafe sex, binge eating, reckless driving or substance use
- Self-harm, suicidal threats or suicidal behavior
- Intense mood shifts that can last from a few hours to a few days
- Chronic feelings of emptiness
- Intense anger that is hard to control
- Stress-related paranoia or feeling cut off from yourself or reality
BPD is often misunderstood and stigmatized, even in health care settings. The truth is more hopeful. With appropriate treatment, many people with BPD experience fewer and less severe symptoms over time and build more stable lives.
What Causes Borderline Personality Disorder?
There is no single cause. Researchers believe BPD develops from a combination of factors. Family history plays a role, as BPD appears more often in people with close relatives who have it. Differences in the brain areas that manage emotion and impulse control may also contribute. Many people with BPD have experienced trauma, abuse, neglect or early separation from caregivers, though not everyone does. BPD is not caused by weakness or a choice to be difficult, and families are not simply to blame.
Why BPD and Substance Use Often Occur Together
The core struggle in BPD is emotion regulation: feelings rise quickly, hit hard and take a long time to settle. Alcohol and drugs can offer fast, if temporary, relief from that pain. Impulsivity makes it harder to pause before using. Many people with BPD also have histories of trauma or invalidating environments, which raise the risk for both conditions.
Relationship conflict is another trigger. A perceived rejection can set off overwhelming panic or rage, and using may feel like the only way to get through the night.
How Substance Use Makes BPD Harder
Substances can deepen the very symptoms people are trying to escape. Intoxication lowers inhibitions, which can increase the risk of self-harm and suicidal behavior. The crash that follows drinking or drug use often brings shame, low mood and more emotional instability. Over time, substance use strains relationships further, feeding the fear of abandonment that sits at the center of BPD.
Some substances also carry dangerous withdrawal. Withdrawal from alcohol and benzodiazepines can be life-threatening and should always be medically supervised.
Warning Signs That Help Is Needed
- Drinking or using after conflict, rejection or intense emotions
- Needing more of a substance to get the same calming effect
- Self-harm that happens more often or while intoxicated
- Relationships, work or housing falling apart
- Feeling unable to cope without alcohol or drugs
Treatment That Addresses Both Conditions
Dialectical behavior therapy (DBT) was originally developed to help people with chronic suicidal behavior and has become a well-studied treatment for BPD. It has also been adapted for people with substance use disorders. DBT teaches practical skills in areas such as:
- Mindfulness: noticing thoughts and feelings without being swept away by them
- Distress tolerance: getting through a crisis without making it worse
- Emotion regulation: understanding and changing painful emotional patterns
- Interpersonal effectiveness: asking for what you need while protecting relationships and self-respect
Integrated care matters. When BPD symptoms and substance use are treated by the same team at the same time, the plan can account for how they feed each other. Medication is not usually the main treatment for BPD, but it may help with co-occurring depression, anxiety or other symptoms.
How Promises DFW Can Help
Promises Dallas-Fort Worth offers dual diagnosis treatment for adults facing mental health conditions and substance use together, along with medical detox when withdrawal needs supervision. Care draws on DBT, cognitive behavioral therapy, trauma-informed care, mindfulness-based approaches and individual, group and family therapy. Our admissions team can talk with you about whether our mental health treatment programs are a good fit for your needs.
If you love someone with BPD, you may be exhausted and unsure how to help. Our page on supporting a loved one offers guidance on setting boundaries while staying connected.
Frequently Asked Questions
Is borderline personality disorder treatable?
Yes. Skills-based therapies like DBT are designed for the symptoms of BPD, and many people see their symptoms ease with consistent treatment.
Is self-harm the same as a suicide attempt?
Not always, but any self-harm is a sign of serious distress and should be taken seriously. Call or text 988 for support, or call 911 if there is an injury or immediate danger.
Should BPD and addiction be treated at the same time?
Generally, yes. Treating both together helps prevent one condition from undoing progress on the other.
Is there a medication for BPD?
No medication is approved specifically for BPD. Medications may still help with related symptoms, such as depression or anxiety, as part of a broader treatment plan built around therapy.
Reach Out for Integrated Care
Intense emotions and substance use can make life feel like one crisis after another. It does not have to stay that way. Call our 24/7 admissions line at (469) 546-9303, explore insurance options or contact us confidentially online.