A Dangerous Duality: Healing from Borderline Personality Disorder and Co-Occurring Alcoholism


Amy Dresner was diagnosed with Borderline Personality Disorder (BPD) in 2004, a fact she discovered only by looking up the diagnostic code printed on the bottom of a bill from her psychiatrist’s office.

Confused, she turned to Google for answers, where she found herself looking at a list of symptoms describing serious emotional volatility, sexual acting out, self-injury, suicidal ideation, and intense fear of abandonment:

People with BPD, it said, idealize and then devalue or demonize people and have a tendency toward “splitting” or black-and-white thinking. They are extremely moody and have a very unstable sense of self. Perceived rejection or failure can trigger long-lasting states of depression, anger, or anxiety. And while they know that BPD is much more common among young women, they don’t entirely know what causes it, though it’s thought to be a combination of genetic predisposition and early trauma.

The description may as well have had her picture beside it. While initially horrified to see herself in such stark light, she soon found comfort in the fact that she now had an explanation for why she was the way she was. She had reasons. And one of the biggest moments of clarity came when she discovered that Borderline Personality Disorder was commonly accompanied by substance abuse. As an alcoholic, she had made several attempts to gain control of her drinking, but even as “the list of medications and rehabs grew longer with every year,” she found herself relapsing again and again, unable to gain a firm grip on sobriety. Now, she understood why.

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Borderline Personality Disorder and Co-Occurring Alcoholism

Mental health disorders and alcoholism often go hand-in-hand and the complex interplay between the two is increasingly becoming recognized within the therapeutic and recovery communities. However, as awareness of the relationship between alcohol addiction and psychiatric illnesses like depression, anxiety, PTSD, and bipolar disorder expands, people with BPD — which has one of the highest rates of co-occurring alcoholism — are too often left out of these conversations.

Researchers estimate that 50-70% of people with BPD simultaneously experience a substance use disorder, with alcoholism topping the list. The reasons for this extraordinary rate of concurrence are deeply rooted in the multidimensional symotomatologies of BPD itself. Dr. Joseph Troncale , Medical Director of Retreat at Lancaster County, writes, “What we see in the lives of people with BPD is, in a word, chaos.” The lack of emotional regulation, interpersonal difficulties, unstable sense of self, extreme vulnerability to distress, and lack of healthy coping skills all make alcohol a welcoming escape from the world of unrelenting turmoil in which you are living.

While other mental heath disorders can create similar psychosocial conditions for alcohol addiction to take root, BPD has two features that often obliterate the natural self-protecting instincts that can temper alcohol use even in people with other forms of mental illness: extreme impulsivity and self-harm. The propensity to act on self-destructive impulse and, more alarmingly, the deliberate desire to seek out self-destruction disrupt not only the ability to limit alcohol use, but may remove the desire to do so in the first place, significantly heightening the potential for damage. “Addiction plus BPD can be lethal as BPD patients are more likely to be suicidal and impulsive to begin with,” Dr. Troncale says. “Add alcohol or drugs and the ability to prevent self-harm goes out the window.”

Substitution For Attachment

There may also be another unique component of Borderline Personality Disorder that invites and strengthens the establishment of alcoholism: lack of secure attachments. Many experts believe that the disturbance of secure attachment in early childhood and ongoing insecurity of attachment in adulthood are central to the formation and articulation of BPD. In fact, many of the behaviors that have come to characterize BPD may be subconscious, maladaptive attempts to access the secure attachments not afforded by your formative experiences. Now, a growing body of neurobiological research “suggests that substance use in some persons can serve as a substitute for unmet attachment needs.” As Dr. Robert J Gregory, professor and chair of Psychiatry and Behavioral Sciences at Upstate University Hospital, writes:

In large prospective studies in Denmark, early weaning from breast-feeding has been associated with the development of alcoholism in adulthood. These findings are similar to findings in animal studies. Barr and colleagues found that macaque monkeys separated from their mothers developed higher levels of ethanol preference. Satisfaction of unmet attachment needs may make substances particularly attractive to patients with BPD, who may otherwise exhibit pathologic interpersonal dependency.

As such, alcoholism in people with BPD may be more than an escape or numbing of pain; it may be a way of attempting to fulfill deeply primal psychological needs, creating a particularly strong and powerful bond with harmful substance use. This may explain why people with BPD tend to have earlier onset of drinking, higher levels of alcohol use, and more relapses after alcohol addiction treatment.

Concurrent Treatment For True Relief

The uniquely close relationship between BPD and alcoholism may be one of the reasons discrete BPD treatments and alcohol addiction treatments have traditionally had such low success rates. Research reveals that people with BPD and co-occurring substance use are significantly less likely to experience remission of BPD symptoms and are at much higher risk of restarting alcohol use. The reciprocal and mutually reinforcing nature of BPD and alcohol addiction must be acknowledged in order to fortify the self-awareness of people who suffer from these conditions and offer meaningful treatment options.

At Bridges to Recovery, our renowned team of psychiatrists, psychologists, and therapists have the training and experience to provide effective, evidence-based treatment for people suffering from Borderline Personality Disorder and co-occurring alcoholism. Through a personalized program of integrative therapies, the full scope of your needs will be addressed with compassion, understanding, and care to expand your ability to live the life you want.

Our curriculum includes the most effective therapeutic modalities available, including Dialectical Behavior Therapy, which has long been considered the gold standard for guiding those with BPD toward healing. Because many people with BPD have histories of childhood neglect, sexual abuse, and physical violence, we also offer cutting-edge trauma-focused therapies to break through the hold these traumatic events have on you and help you find freedom from distress. Throughout your therapeutic experience, your unhealthy relationship with alcohol can be explored and re-framed to allow you to establish true and lasting sobriety. By receiving support for your full range of emotional and behavioral needs, you can gain the insight, stability, and skills to flourish.

Bridges to Recovery offers comprehensive treatment for people living with Borderline Personality Disorder and co-occurring alcohol addiction. Contact us to learn more about our innovative program and how we can help you or your loved one on the path to healing.

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