Borderline Personality Disorder and Addiction
Why They Commonly Co-Occur and How Treatment Helps
Borderline personality disorder (BPD) and substance use disorders frequently overlap. Many people living with BPD symptoms experience intense emotional pain, rapid shifts in mood, chronic feelings of emptiness, and relationship instability. Substances can become a fast, short-term way to numb distress, slow racing thoughts, or escape overwhelming feelings. Over time, that coping strategy can develop into a substance use disorder and reinforce the very symptoms a person is trying to manage.
This article explains how BPD and addiction interact, what to look for, and what evidence-based treatment typically includes. If you want a broader overview of personality disorders first, start here:
Personality Disorders Explained.
What Is Borderline Personality Disorder?
Borderline personality disorder is a mental health condition characterized by pervasive patterns of emotional and interpersonal instability. People with BPD are not “being dramatic” or “trying to manipulate.” Symptoms are often rooted in difficulty regulating emotions, heightened sensitivity to rejection or abandonment, and learned coping strategies that can become maladaptive over time.
Common symptoms may include:
- Intense emotional reactions that can feel sudden and difficult to calm
- Fear of abandonment (real or perceived) and strong reactions to separation or conflict
- Unstable relationships that may shift quickly between closeness and rupture
- Impulsivity (spending, sex, substances, risky decisions) especially during distress
- Chronic emptiness, shame, or an unstable sense of self
- Self-harm thoughts or behaviors for some individuals
A qualified clinician should make the diagnosis after a comprehensive assessment that considers trauma history, mood symptoms, substance use timeline, medical factors, and overall functioning.
Why BPD and Addiction Often Overlap
The overlap between BPD and substance use is not accidental. It is often driven by a cycle:
- Emotional pain or stress triggers intense reactions (anxiety, anger, panic, shame).
- Substances provide rapid relief (numbing, calming, dissociation, social ease).
- Relief reinforces use, the brain learns that substances “work” fast.
- Consequences accumulate (withdrawal, conflict, guilt, health problems, legal/work issues).
- Symptoms intensify (more reactivity, impulsivity, relationship instability), increasing the urge to use.
Alcohol and drugs also disrupt sleep, worsen mood instability, and increase impulsive decision-making. This is why many people feel “stuck” in repeating cycles of relapse, relationship conflict, and emotional crisis unless both conditions are treated together.
Why Integrated Dual Diagnosis Care Matters
If treatment focuses only on sobriety without addressing emotion regulation, relationship patterns, trauma responses, and coping skills, the person may remain highly vulnerable to relapse during stress. Conversely, treating mental health symptoms without directly addressing substance use often leaves a major driver of instability in place.
Integrated care, often called dual diagnosis treatment, addresses mental health and substance use at the same time with one coordinated plan. Learn more about our approach here:
Dual Diagnosis Treatment in Houston.
How Treatment Works for BPD and Substance Use
Effective treatment is structured and skills-based. The goal is not simply to “stop using,” but to build a life and a nervous system that can tolerate stress without needing substances to survive it.
1) Skills-Based Therapy: DBT
Dialectical Behavior Therapy (DBT) is one of the most widely recognized treatments for BPD. DBT teaches practical skills in four core areas:
- Mindfulness: noticing emotions and urges without immediately reacting
- Distress tolerance: getting through crises without making them worse
- Emotion regulation: reducing vulnerability to emotional “spikes” and improving stability
- Interpersonal effectiveness: boundaries, communication, repair, and conflict navigation
If DBT is part of your care plan, link to your program page here:
Dialectical Behavior Therapy (DBT) at The Heights Treatment.
2) Relapse Prevention That Matches Emotional Triggers
Relapse prevention for BPD must account for the most common relapse drivers: abandonment fears, conflict, shame spirals, loneliness, boredom, and emotional overwhelm. Treatment should include:
- Identifying emotional and relational triggers (not just people/places/things)
- Urge surfing and craving-management skills
- Plans for high-risk moments (after arguments, breakups, job stress, family conflict)
- Repair strategies for relapse slips without self-destruction or shame withdrawal
3) Trauma-Informed Care When Appropriate
Many people with BPD symptoms have trauma histories. Trauma-informed care means treatment does not force disclosure or “dig” prematurely. Instead, it prioritizes safety, stabilization, and skills first, and only progresses into deeper trauma work when clinically appropriate and the person has adequate supports.
4) Psychiatric Evaluation and Medication Management for Co-Occurring Conditions
No medication “cures” BPD. However, a psychiatric evaluation may be helpful when co-occurring conditions are present, such as depression, anxiety, PTSD, sleep disorders, or mood instability. Medication can reduce symptom burden and improve the ability to engage in therapy and recovery routines.
How Families and Loved Ones Can Help
Families often feel exhausted, confused, or helpless, especially when substance use and emotional crises overlap. Support is most effective when it is structured and consistent.
- Validate emotions without validating harmful behavior. (“I can see this hurts. We still need to keep you safe.”)
- Set calm, consistent boundaries. Inconsistency often increases escalation.
- Avoid power struggles during crises. Focus on safety and next steps.
- Encourage treatment engagement rather than trying to “reason” someone out of dysregulation.
If you are unsure how to support a loved one without enabling substance use or escalating conflict, professional guidance can help establish a stable plan.
When to Seek a Higher Level of Care
Consider a higher level of support (such as PHP or IOP) when any of the following are present:
- Frequent relapses or inability to maintain stability outside of structure
- Self-harm thoughts or behaviors
- Escalating relationship conflict and unsafe impulsivity
- Substance use that worsens mood instability, sleep, and functioning
- Repeated crises that disrupt work, school, parenting, or daily life
If there is immediate danger, overdose risk, or imminent self-harm risk, seek urgent help right away. In the U.S., you can call 988 for immediate support.
Read Next: Related Personality Disorder Guides
Continue through our personality disorder series:
- Personality Disorders Explained: Types, Symptoms, Diagnosis, and Treatment
- Narcissistic Personality Disorder vs. Narcissistic Traits
- Antisocial Personality Disorder: Myths, Risks, and Treatment
- OCPD: When Perfectionism and Control Become a Problem
Medical Disclaimer
This content is for educational purposes and is not a substitute for professional diagnosis or treatment. If you or someone you love is in immediate danger or at risk of self-harm, call 988 (U.S.) or go to the nearest emergency department.
