Dual Diagnosis Treatment for Borderline Personality Disorder

Many people who have Borderline Personality Disorder also have a substance abuse problem. This is called a “dual diagnosis.” Dual diagnosis treatment for Borderline Personality Disorder is available to help these patients; however, it is complicated, since there is controversy over which disorder should be treated first.

Failures in traditional treatment for dually diagnosed people are often a result of the failure to consider the actual function of the addiction in the person’s life, within the context of the characteristics of his/her Borderline Personality Disorder. The inner forces that initiate and sustain the person’s addiction are: (1) immaturity; and (2) inappropriate, negative coping techniques.

Dual diagnosis treatment must involve recognition of the person’s tendencies which foster their addictive behavior; such as: immaturity, escapism, and grandiosity. New ways must be learned for dealing with their feelings of powerlessness and helplessness, other than compulsivity.

When people with Borderline Personality Disorder cannot find self-comfort, they flee into impulsive acts and behaviors such as: self-mutilation, risky sex, binge/purge eating, alcohol and drug abuse, excessive spending (or shoplifting), excessive gambling, etc. Impulsive and self-destructive behaviors temporarily allow them to feel calmer.

Conversely, panic is a significant and frequent reaction to confrontation of their alcohol and drug use and/or compulsive behaviors. The alcohol and drug use and/or compulsive behavior may have become so important to the person that it is perceived as necessary for their survival. This panic can be the cause of lying, avoidance, or treatment withdrawal if they are confronted with their behavior. To them, life without the drug of choice (or compulsive behavior) seems impossible and incomprehensible.

When individuals with Borderline Personality Disorder, who have not previously reported other compulsive behaviors, are able to achieve abstinence from their drug of choice, mental health professionals must address the possibility of (or check for) alternative addictive involvement, such as: excessive shopping (or shoplifting), impulsive and unsafe sexual behavior, eating disorders, self-injurious behaviors, and/or gambling. Recovery programs must cover all addictive patterns.

Dual diagnosis treatment for addicted people with Borderline Personality Disorder must address the function of the addictive substance and/or compulsive behaviors while developing strong substitutes that can sustain recovery behaviors and abstinence, such as: involvement in Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) – including recovery behaviors such as daily contact with sponsors; affect management (particularly anger); medication compliance; self-calming techniques (relaxation and meditation); and therapy for issues related to a family history of physical and/or sexual abuse.

Twelve-step group participation may be a more successful process for people with Borderline Personality Disorder with 12-step practice sessions. These individuals should be helped to organize their thoughts and to practice saying “Pass” when feeling unsafe. They should be encouraged to join same sex groups when possible and use same sex sponsors. If possible, sponsors should be brought into a treatment session to learn why individuals with Borderline Personality Disorder are taking medication and to discuss setting boundaries.

Relapse for individuals with Borderline Personality Disorder is defined as engaging in any unsafe (self-destructive) behavior, such as: alcohol and drug abuse, self-harm, and medication noncompliance. Relapse prevention must focus on both preventing alcohol and drug abuse, and recurrence of the person’s Borderline Personality Disorder symptoms.

Confrontation usual to substance abuse treatment may be useful with high-functioning people with Borderline Personality Disorder; however, it will overwhelm lower-functioning people with Borderline Personality Disorder. Mental health professionals must be aware of the severity of symptoms in each person with Borderline Personality Disorder when deciding on the use of confrontation techniques.

Abstinence from abusive substances can be a prerequisite to treatment for Borderline Personality Disorder only with very high-functioning individuals with Borderline Personality Disorder; otherwise, it needs to be a goal of treatment.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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