A Dangerous Duality: Healing from 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.”

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.