Borderline personality disorders (BPDs) and substance abuse issues tend to go hand in hand. According to an article published in Australian Family Physician, up to 65 percent of people who enter treatment programs for substance abuse also meet the criteria for BPDs. There are a variety of reasons why the two conditions tend to augment and support one another, and those reasons will be fully explained later in this article, but there is one message that’s worth stating right away. When BPD and substance abuse are treated jointly in a Dual Diagnosis program, real recovery can take place. It’s possible to recover from both conditions, with the right kind of therapy. This is the sort of program we offer at Michael’s House, and we’re available to talk about our treatment program with you at any time – 24 hours per day. Please contact us and find out more about our Dual Diagnosis and borderline personality disorder programs.
A Misleading Name
Having BPD doesn’t mean that the person has dual personalities or is somehow on the border between sanity and illness. The name doesn’t describe the illness in any way. It’s a problem that the medical community is aware of, but hasn’t yet set out to solve. When mental health disorders are discovered, researchers work hard to make sure that those conditions aren’t minor variations to diseases that already exist. This has some benefits for patients, as it ensures that patients with minor variants of existing conditions can get the help they need relatively quickly. But, it can have some unintended consequences. When researchers began discussing BPD, some believed they were working with an unusual form of other mental health problems they already knew about. They therefore called this disorder a “borderline” problem, as it seemed to fit right in with other conditions if it was just tweaked in a small way.
This all changed in 1980, according to the National Institute of Mental Health (NIMH), when the condition was included in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III). When a condition is included in a mental health book in this way, it’s considered its own separate disorder, and doctors can begin to separate people who have this specific disorder from people who have other similar mental health issues.
Symptoms of BPD
For people who have BPD, the world can be seen in strict black-and-white terms. People are either all good or all bad. Things are either happy or sad. Judgments are made quickly, and there is no room for negotiation. In addition, people with BPD may have difficulty accepting negative situations, trying hard to get involved and make things go a certain way. They may also have a significant amount of difficulty maintaining relationships with other people, as their behavior may be seen as erratic, dangerous or negative. While people with BPD are often desperately afraid of being abandoned, their behavior may serve to push people away.
People who have BPD also tend to:
- Seem irritable
- Explode with anger
- Threaten to commit suicide
- Feel empty or bored
- Seem unable to plan for the future or set goals
The National Alliance on Mental Illness reports that about 50 percent of people with BPD experience symptoms of severe depression. Unlike a feeling of sadness that might come and go in the healthiest of people, this severe depression may keep the person from feeling healthy enough to sleep, work or spend time with loved ones.
People with BPD also tend to engage in impulsive behavior. They may spend money recklessly, drive too quickly or eat huge amounts of food in one sitting. They may also engage in drug or alcohol abuse as part of this impulsivity. Resisting the temptation to use drugs and alcohol means weighing the pleasures felt in the moment with the consequences that are sure to come down the line. People with impulsivity problems cannot do this sort of mental balancing. Instead, they can only see the benefits that might come in the moment, and drugs and alcohol may be harder to resist as a result.
A Biochemical View
While it might be easy to see how living with BPD could drive someone to substance use and abuse, it’s also possible that substance abuse could cause symptoms of BPD to appear. For example, an article published in the American Journal of Psychiatry found that people who had BPD tended to have low levels of opioids, or natural “feel-good” chemicals, circulating in their bloodstreams. As a result, these people engage in dangerous behaviors like harming themselves to force their bodies to create more of the natural chemicals they crave. These people might also resort to taking drugs like heroin, as they mimic the effects of the natural opioids the body should be producing. Interestingly, the researchers report that people with BPD who use drugs tend to feel just normal while on the drugs, rather than feeling euphoria. In other words, the wiring issue that causes the BPD might be causing so much distress that the person resorts to drug use to help correct the imbalance.
It’s possible that some of these chemical issues are caused through heredity, but it’s also possible that these changes come about as a response to trauma that started early in life and lasted for a long time. An article provided by the American Academy of Experts in Traumatic Stress suggests that people who are exposed to stress prior to age five develop an exaggerated neurochemical response when they’re later exposed to stress. Their nerve endings seem to be attuned to stress chemicals, as this is the way they’ve trained their bodies due to the long-term stress they have endured. For these people, substance abuse is a method of numbing and soothing those attenuated nerves, making it easier for the person to get through the day without reacting to anything and everything.
Consequences of Dual Diagnosis
A study published in the Canadian Journal of Psychiatry highlights the severe impact that a substance abuse issue can have on a person with BPD. Here, people who had a Dual Diagnosis of BPD and addiction were less likely to heal from BPD compared to people who did not have an addiction issue. In addition, they were likely to demonstrate more suicidal and psychotic behaviors than people who did not have an addiction issue. It’s clear that the two conditions can augment one another in severity, and both problems can become quite acute in a short period of time.
Substance abuse can also give a person with BPD a greater opportunity to do harm. People with BPD may already feel an urge to commit suicide or harm themselves in some other way, and it may lead them to take stronger doses of drugs or even try to overdose on the drugs. Substance abuse can also further isolate the person from friends and family, leading to even greater feelings of isolation and depression.
Goal of Treatment
Regardless of whether the BPD caused the substance abuse, or if the substance abuse caused symptoms of BPD, treatment is designed to help the person leave behind destructive behaviors. In Dual Diagnosis treatment, this often means that early stages of treatment are focused on helping the person stop abusing substances of any sort. People with this Dual Diagnosis are often encouraged to go through withdrawal stages in a facility, with the help of a therapist. Weaning away from drug and alcohol use can cause anxiety in almost anyone, but people with BPD may have even greater sensations of anxiety, and they may need additional help in order to get through detoxification without relapsing to substance abuse.
Once detoxification is over, therapy begins in earnest. There are a variety of techniques therapists can use, but types commonly chosen include:
- Cognitive Behavioral Therapy helps the person to change core beliefs and learn to steer clear of dangerous situations.
- Dialectical Behavior Therapy helps the person learn to live in the moment, accepting what comes, and reducing the emotional response to given triggers.
- Schema-focused therapy addresses how the person views the self and his/her place in the world.
- Family therapy allows the entire family to learn new ways of communicating with one another.
While no specific medications have been developed to assist people with BPD, some people benefit from medications that help to reduce feelings of depression or anxiety. NIMH reports that many people with BPD do not need, or benefit, from medications, and they instead find the most help in therapeutic programs. There are some people, however, who truly do need medications in order to keep symptoms under control. People who are recovering from addictions to heroin or prescription medications, for example, might need medications in order to curb the cravings for drug use that they feel on a regular basis. This is a personal decision the person makes in consultation with the therapist.
The Importance of Treatment
While it’s true that people could choose to focus solely on their mental illness or solely on their substance abuse, experts suggest that both conditions should be treated at the same time in order for the person to see the greatest chance of success. While it might be true that BPD came first, and addiction came as the person tried to live with the illness, treating only the BPD still leaves the addiction intact and it will not go away on its own. In fact, the addiction could lead the person back into impulsive behavior, and a resurgence of other BPD symptoms. Both conditions should be treated simultaneously.
If you’re dealing with BPD and an addiction, we urge you to contact us at Michael’s House and learn more about our Dual Diagnosis programs. Recovery is possible, and we hope you’ll call us today.