Co-occurring care
Personality Disorder and Addiction Treatment
Borderline personality disorder distorts how a person sees themselves and the people around them. When substance use enters the picture, both conditions need treatment — together.
About this condition
Borderline personality disorder treatment
A personality disorder is a persistent pattern of thoughts and behaviors that deviates greatly from cultural expectations and impairs daily functioning; the DSM-5 describes ten types across three clusters. Borderline personality disorder (BPD) affects an estimated 4.6 million adults in the United States, and 38% of people diagnosed with BPD also experience substance addiction — a combination known as a dual diagnosis.
A hallmark of BPD is an exacerbated fear of abandonment, which can trigger mood swings, an unstable self-image, and difficulty regulating emotions and behavior. Symptoms usually present in early adulthood and tend to ease with age — and with treatment. When drugs or alcohol become a way to cope, the two conditions feed each other, which is why integrated treatment matters.
BPD and addiction treatment is provided at Ambrosia's Neuroscience Institute in West Palm Beach, with personalized plans that address both conditions simultaneously rather than one at a time.
Signs and symptoms of BPD
BPD shares many symptoms with other mental illnesses, which makes it difficult to diagnose — and it often appears alongside depression, anxiety disorders, eating disorders, substance abuse, bipolar disorder, ADHD, or PTSD. If you or someone you love is talking about suicide or self-harm, tell someone now — call or text 988 to reach the Suicide and Crisis Lifeline and be connected with a trained counselor. Characteristic signs of BPD include:
- Rapidly shifting ideals, identity, or self-image
- Going to great lengths to avoid separation or rejection in relationships
- Unstable relationships that swing between idealizing a partner and suddenly viewing them as cruel or uncaring
- Threats of suicide or self-harm
- Mood swings lasting hours to days, sometimes with intense rage
- Poor self-image and feelings of worthlessness
- Periods of paranoia and difficulty connecting with reality
- Impulsive, risky behavior such as drug abuse, gambling, or unprotected sex
- Feelings of hopelessness and emptiness
Causes and risk factors
The exact cause of BPD is largely unknown. Research points to changes in the brain areas responsible for emotional regulation, aggression, and impulsivity, and evidence suggests the brain chemicals that regulate mood are not working optimally in people with BPD. Genetics play a role too — mental illness tends to run in families, and a close relative with BPD or another mental health condition raises the risk.
Environmental factors that shape personality development are also thought to contribute: an unstable childhood environment, neglect or abandonment by a primary caretaker, sexual or physical abuse during childhood, and parental substance abuse.
BPD and substance use: the connection
When someone with a personality disorder lacks effective coping mechanisms, drugs or alcohol can become a form of self-medication — a way to feel better about themselves, hide feelings of social incapacity, or escape negative thoughts. Prolonged self-medication can become a substance use disorder, and as the addiction progresses, the personality disorder typically escalates with it.
Both conditions affect the interconnected brain regions responsible for reward, impulse control, and emotional regulation. Someone already predisposed to emotional volatility becomes further compromised in managing impulses and making decisions — which makes engaging in treatment harder, and integrated dual-diagnosis care more important.
Risks of untreated BPD
BPD affects how a person experiences every relationship — at school, at work, in friendships and romantic life. Left untreated, the consequences compound:
- Unstable or abusive relationships
- Inability to finish school
- Frequent job changes or unemployment
- Divorce or separation
- Self-harm
- Money or legal troubles
- Sexually transmitted infections
- Suicide attempts
- Escalating substance use
How we treat BPD and addiction
People with personality disorders may deny the problem or resist the idea of treatment, so plans are built around each person's circumstances and goals. Behavioral therapies — cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) — have proven highly effective for treating a personality disorder and addiction together, supported by individual, group, and family therapy, EMDR, neurofeedback, skills training, prescribed medications such as antidepressants or antipsychotics, relapse prevention, support groups, and consistent aftercare.
Treatment runs at two levels: a residential program where clients live on-site and heal away from everyday stressors, and an intensive outpatient program with treatment three to five days a week for several hours at a time — structure that still leaves room for personal and work commitments.
Ready to talk with admissions?
Admissions is available 24/7 to answer questions about mental health and substance use treatment options.