Substance Use Disorders in Patients with Borderline Disorder

Consequences of Abuse of Alcohol and Street Drugs in Borderline Disorder

  • dramatic worsening of the symptoms of borderline disorder
  • marked decrease in the effectiveness of medications and psychotherapy
  • addiction to and sustained craving for these substances

About two-thirds of people with borderline disorder seriously abuse alcohol, street drugs, and/or prescribed drugs. This is a major factor that, if not corrected, contributes to poor treatment outcome of people with the disorder. Alcohol and drugs are often abused by people with borderline disorder to temporarily relieve the severe emotional pain that they experience, especially when under stress. Predictably, this relief is short-lived. Even worse, the use of these substances markedly increases many of the symptoms of borderline disorder, making substance abuse treatment all the more important.

It seems likely that some of the genetic risk factors in borderline disorder may also be among the group of genetic factors that predispose people to alcoholism and drug abuse.

More About the Importance of Substance Abuse and its Treatment in People with Borderline Disorder

DSM-5 Criteria and Substance-Related Disorders:

There has been a significant revision in the classification and criteria of mental disorders that are listed in this category in DSM-5 compared to those in DSM-IV TR. It is beyond the purpose and scope of this Website on borderline disorder  to describe these changes in detail. For us, it is sufficient to recognize that there is no stronger predictor of poor outcome of borderline disorder, either untreated or treated, than the continued use or abuse of alcohol and/or addictive drugs.

Because the description of Substance-Related Disorders in DSM-5 is very comprehensive, it may be more helpful if I list for you the criteria used for these disorders in DSM-IV TR. That classification  lists two types of substance use disorders: 1) substance dependence; and 2) substance abuse. Substance abuse treatment is important in both types of substance use disorders.

Substance Dependence

A pattern of substance use that leads to significant impairment or distress in three (or more) of the following ways:

Substance Abuse

A pattern of substance use that leads to significant impairment or distress in one (or more) of the following ways:

Substance Abuse Treatment Interventions

Because of the numerous disruptions caused by these disorders, I strongly advise my patients with borderline disorder to not use alcohol, to not take any street drugs, and to take prescribed medications only as ordered by their physicians. In addition, I encourage those patients who have a substance-use disorder to engage fully in a substance abuse treatment program and attend support groups (e.g., Alcoholics Anonymous or Narcotics Anonymous). I also suggest to some of them that they may benefit from a trial on a medication appropriate for their specific drug dependency, as this may help reduce craving and use.


Substance-use disorders are major predictors of poor short- and long-term outcomes of borderline disorder.