What does the research say about the co-occurrence of borderline personality disorder (BPD) and substance use disorders (SUDs)?
A group of researchers at the University of Missouri at Columbia, led by Timothy Trull asked this question in 2000–and then they asked it again in 2018 to see if the answer had changed.
Their first research program reviewed 36 studies from prior to 2000. Then they looked at a total of 70 studies that were published between 2000 and 2017.
The studies of people with BPD included approximately 1500 individuals. The studies of people with SUDs had a total of over 10,000 persons. Populations in both groups included inpatient, outpatient, and in the general public.
The estimates from both reviews are fairly consistent:
Approximately half of those with BPD also have at least one current SUD. Among those with a specific SUD diagnosis, approximately 25% also meet criteria for BPD.
BPD and SUD can be both be understood as an expression of impaired impulse control and emotional dysregulation. The effect of substance use exacerbates a personality disorder and contributes to its chronicity. Chronic distress will increase the risk of substance use and addiction. There is a transactional dynamic that can make this combination much more difficult to treat. Thus it can cause extremely high level of distress among the families and loved ones of a person with these co-occurring disorders. Moreover, relapse seems to be part of the process of recovery and this episodic nature of recovery is especially difficult for family members. Both BPD and SUD have genetic influences and there may be others in the family who are also suffering with at least one of these issues.
The implications of these co-occurring disorders for treatment are extremely important, but there are few randomized controlled trials that directly assess the effects of treatment on persons with SUD-related problems and BPD. Variations of Dialectical Behavior Therapy, the strongest evidence-based treatment for BPD, are emerging to address co-occurring BPD and SUD, but lots more research is needed.