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Substance Abuse and Borderline Personality Disorder

Substance abuse is prevalent in people who have Borderline Personality Disorder. Many people who present with Borderline Personality Disorder are dual-diagnosed with a substance abuse problem as well. This is called co-morbidity, or having two disorders at the same time. The problem is that in order to help the person with Borderline Personality Disorder, the substance abuse issue has to be dealt with as well, usually first.

People who have Borderline Personality Disorder experience extreme problems with impulsivity and in controlling their emotions. They are frequently agitated, anxious, depressed, and overwhelmed. They usually do not see themselves as able or effective in managing their own lives. Their defenses are regressive; under stress they become more childlike. Drugs and alcohol can offer these individuals a way of coping. Drugs can block out sensations of pain and discomfort, whether this is physical pain or emotional pain. Either way, this pain is very real to the person experiencing it.

The appeal of drugs and other compulsive behaviors (such as eating disorders, risky sexual behavior, self-mutilation, and/or excessive spending or gambling) in soothing, distracting, and escaping is apparent and powerful for people with Borderline Personality Disorder. Those who have this disorder typically develop the addictive traits that fall easily into addictive disorders as well. These individuals will use almost any drug to ease their suffering. They often abuse prescribed medications and may hoard these medications for suicide attempts.

People with Borderline Personality Disorder often use alcohol and drugs in a chaotic and unpredictable way, and/or they may engage in a pattern of drug use, or “self-medicating,” involving alcohol and other sedative-type medications as a way of relieving their “emotional pain.” Patients with Borderline Personality Disorder often abuse Benzodiazepines which have been prescribed for anxiety, and which can lead to a relapse to their actual primary drug of choice.

The issue of prescribed medication for people with Borderline Personality Disorder is complex and difficult. People with the disorder often demand medication for anxiety or depression and can become quite angry when denied. They are noncompliant with medication as well – either using too much or too little. They are inclined to misreport the impact of the medication, saying they feel better when they don’t, or worse when they feel better.

Another issue regarding substance abuse in people who have Borderline Personality Disorder has to do with their intolerance for being alone and the intensity of their relationships. These people will often use drugs and alcohol as part of their need for contact with others. The drug of choice will then coincide with that used by their social contacts.

Recovery in these situations will be dependent upon linking those people who have Borderline Personality Disorder to a strong support network that fosters abstinence from abusive substances, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

The problem with abstinence programs such as AA and NA, however, is that of going from one extreme to the other. “Cutting off your nose to spite your face,” as the saying goes. By abstaining from the abused substances, the person with Borderline Personality Disorder may also be abstaining from medication they need to help control the symptoms of the disorder.

The solution to this problem, although a complex one, is that after treating the person’s substance abuse problem, the Borderline Personality Disorder can then be treated medicinally, as long as it is done in a careful and very deliberate manner, taking into consideration the patient’s substance abuse issues.

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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