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The Challenges Of Treating Addicts With Borderline Personality Disorder


Rage. Instability. Mood swings. Impulsivity. These characteristics make people with borderline personality disorder (BPD) prone to substance abuse as well as over-spending, promiscuity, eating disorders and other compulsive behaviors. In fact, studies suggest that 50 to 70 percent of those with BPD also have a co-occurring substance use disorder.

Addicts with co-occurring borderline personality disorder are known as some of the most difficult patients to treat. Here are a few of the most common challenges, along with insights into the most effective research-based treatments:

Treatment Compliance

Addicts with BPD have been described as both treatment demanding and treatment resistant. Research shows more positive outcomes the longer an addict with BPD stays in treatment, yet keeping them in treatment is no easy task. In a study of patients in a detox program, those with BPD were significantly more likely to have an unplanned discharge than those without BPD.

While a number of treatments have proven effective for BPD, therapies for BPD patients with co-occurring substance abuse are less established. Studies suggest that the most promising treatments include dialectical behavior therapy, cognitive-behavioral therapy and psychodynamic approaches. A combination of support and management from an experienced dual diagnosis treatment center can improve retention rates, along with ongoing involvement in self-help groups such as AA and NA.

11 Comments to
The Challenges Of Treating Addicts With Borderline Personality Disorder

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  1. Addicted to cutting, burning, sleeping in the open, going missing and not eating and over exercising.

    • Jackie, we can’t really diagnose or treat people through this site. However, if you tell me your city I may be able to send you a resource/hotline that might help.

      • Dr. Sack, could you please send me a referral or resource for alcohol recovery around Dallas or Denton, TX? My son has failed his first attempt (only went for 3 days after suffering seizures) and believes he can handle it on his own, but obviously cannot. Trying to hold his family, home and work together but near the breaking point. He’s on medication for the seizures and still drinking worse & worse. He needs help.

  2. It’s definitely a challenging therapeutic relationship. The goal for substance dependent individuals is abstinence. But individuals dealing with substance dependance who also have BPD are frequently using substances to cope with their chaotic interior and exterior realities. For these people abstinence makes BPD harder to live with. The client needs to have a lot of trust in the therapist to move through that discomfort.

  3. I am an alcoholic with Borderline Personality Disorder, in recovery from both now. In order to recover, it was vital for me to treat both at once. DBT was very important in sorting out my BPD, as I found I relapsed with the alcoholism due to being unable to control my emotions and my impulse to drink when upset.

    Recovery is great – I hardly even register on the BPD scale now. It was a lot of work, but absolutely worth it!

    Beth Burgess
    Sort My Life Solutions

  4. Beth’s post stating that now she is in recovery she hardly registers on the BPD scale is indicative of how people with substance use disorders can display traits of personality disorders, but not have a true disorder. I am very suspicious of a personality disorder that is diagnosed when one is using substances or in early recovery.

  5. I have been in psch treatment now for over 14 years My diagnosis with BPD did not come until after ten years into therapy. After realization of this my therapist swiftly sent o a person who had training inBpd. As you know change is terrifying to Bpd patients. Because of this swift and unexplained change I built walls that I allow very few into. Until finally finding a therapist who understands and believes what it is to be trapped in my mind I have just leaened to trust him. This is the only person I can say I trust at this moment. That exclusion includes family members. Besides BPD, I also have been diagnosed with moderate reoccuring depression, PTST, severe anxiety. and I yet do not find anything in the variety of medias that even make an attempt to make suggestions on any successful plans for someone with my different combination of illnesses. I do not have the alcohol or drug addictions that I read about all of the time. The only addiction I have is overspending and that in itself causes many other problems. I have been hospitalized several times been in day hospital, took part in many groups and been on medications since the very beginning. I receive no family support and was told by various doctors that because of the endless time for me with so many problems that it maybe best not to discuss these problems with them. They worry andafraid for me and sometimes I think of me. I have signed a safety contract with my current therapist as the risk for me ending it all is a very real possibility. I cannot deal with change of any kind and am working onlearning how to keeo my anger from going from calm to rage in seconds. I have no middle area in any of my emotions. I find myself thinking more and moreabout finding relief from this pain I have endured since I was a child. So perhaps someone out there who is feeling the same way and fits my mold of diagnosis or a therapist could tell me which of the many things I should be trying to rid myself os first We are ofcouse working diligently on the BPD, but I find it most difficult to believe that Ican conquer all of these at once. I am uncertain how much longer I can fight the endless misery of existing. I do not live. I exist.

  6. I am not surprised by the response. Delay and hope she will go away. It has been over 24 hours and no one has been able to attend to my message Well congratulations! You win! I am too tired to continue ti wait for any more answers. I was not a monster just a human being with a difficult illness. My hope is that we can be seen in a different light. my thoughts go out to all who are suffering this endless and controling disorder. I should have kept my walls up and not telling any one. Society is not able to accept us as we are. Perhaps the answer can be found in the next world.

    • Trish, I completely understand how you feel and view the world. I too, have BPD. You’re exactly right when it comes to misery in your mind. It absolutely sucks to have one of the most complicated mental illnesses known to man kind. It’s a pain, like no other .. It’s constant – chronic – and most of the time unmanageable . I was addicted to prescription pain pills for 10 years prior to my current sobriety of five years may 9, 2013..THAT was the easy part of my journey. The hardest part started two years ago while I was i continuing counseling regarding my addiction is when I was diagnosed with BPD. At first it was intriguing , as if my past and all the behavior had finally started to make sense. It was one of those “AH -HA” moments. Then I stopped denying and started to understand just how ill I was and wanted to come out of my skin more than I wanted to be in it. We are prisoners in our own minds. We can’t walk away like everyone else … This is part of who we are..it absolutely sucks.. But we can’t change it. All we can do is learn about ourselves, our behavior and the effect it has on everyone involved on our lives, which usually isn’t a lot – but you know if theyre in , there’re in all the way, which means we are exposed and vulnerable to them… So we hurt them- and drive them away.. When they’re the ones we want and need to stay. Please feel free to email me. I WILL respond- as I am your sister in this painful disease..

  7. My name is shaun I have bpd. I am addicted to cutting(the cutting is for the pain I love it), spending, crystal meth(crystal only every 2 months), weed(every day of my life), use other drugs aswell but once in a blue moon, also mandrax, and the last but the worse I am addicted to lairing(Pathological lair). Now if any one has any solution on how I can detox from all of that please let me know asap. I don’t go to doctors because I nearly beat one to death because they forced me to go.

  8. Sorry forgot to tell you about another one of my dark addictions Lending on a perment basis.

  9. Dr. Sack, could you please send me the name of someone in the Philadelphia area? My son is addicted to oxycotin and has been diagnosed with Borderline Personality Disorder as well. He is 32 years old, married with 4 children and is currently on his way to a recovery house after spending 30 days in rehab. He is only doing this because he has no where else to go. I’m not sure he understands his BPD diagnosis or how it could be treated. He needs help badly. Please reply ASAP ~ thank you!

  10. The causality between the two is unreal. Where BPD ends (or begins) and then saunters into addictive tendencies defies what meager abilities I have been able to bring to bear on the matter in terms of defining and reacting accordingly. With early onset of both potentially running in line with each other and the easy misdiagnosis – or even a correct one which lays yet another layer – of bi-polar disorder, the permutations are seemingly endless. Thank you for sharing.

  11. Dr. Sack, can you recommend a dual treatment facilities in the chicago area. My daughter has bpd and an alcohol dependence. She is in need of a qualified dual treatment center and has cigna insurance. Thank you for taking a moment to help us find hope for getting better

  12. Dr Sack, I don’t know if it’s possible for you to make recommendations for my doctor, or GP, as I’m not getting any help at all at the moment.

    I live in Great Britain, where we rely on the National Health Service for treatment. I was diagnosed with Borderline Personality disorder, Attachment disorder, and Recurrent Depressive disorder about 5 years ago. I was recommended for Mentalizing therapy in a group setting but found it very distressing to listen to other people’s experience, for example one lady said she bathed in bleach every day. So, I haven’t had any therapy since then, as I had to bow out.

    I also was given morphine sustained-release, as well as liquid oxycodone for breakthrough pain ( I had shoulder surgery around the same time as the diagnosis of BPD, etc, and was in a great deal of pain).

    Since that time, my weight has increased by about 50lbs and I am addicted to spending money. The more oxycodone liquid I was prescribed, the worse it got. I now owe the equivalent of $50, 000 in credit cards debt.

    I am at the end of my rope and do not know what to do now.

    Any suggestions would be gratefully received.

    Mart.

 

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