Borderline personality disorder and addiction overlap dramatically — studies estimate that up to 78% of people with borderline personality disorder (BPD) develop a substance use disorder at some point. That is one of the highest co-occurrence rates in mental health, and it is not a coincidence: the same emotional intensity, impulsivity, and pain that define BPD also drive people toward substances as a way to cope. Understanding the link matters because treating one while ignoring the other rarely works, and because there is a therapy designed almost perfectly for this exact combination.
This guide explains why BPD and addiction are so intertwined, how each makes the other worse, why diagnosis can be complicated, and what integrated treatment — especially DBT — looks like. Updated April 2026. Reviewed by the RehabPulse editorial team. This is educational and not medical advice — BPD requires diagnosis and treatment by a qualified clinician.
The 60-second answer
| Question | Short answer |
|---|---|
| How often do they co-occur? | Up to 78% of people with BPD develop a substance use disorder |
| Why are they linked? | Shared emotional dysregulation, impulsivity, and pain |
| What's the core driver? | Using substances to escape unbearable emotions |
| Can you treat just the addiction? | No — untreated BPD tends to drive relapse |
| What therapy helps most? | DBT (dialectical behavior therapy) was built for this |
| Is it harder to treat together? | Yes — but integrated treatment works well |
| Is BPD treatable? | Yes — many people improve substantially |
| Key principle | Treat both, together, with the right therapy |
The single most important point: most people don't know that for someone with BPD, substance use is very often an attempt to regulate emotions that genuinely feel unbearable — not "bad behavior" or weakness. BPD involves intense, rapidly shifting emotions and a deep sensitivity to rejection and abandonment, and substances can offer fast (if destructive) relief. Treating the addiction without addressing that underlying emotional dysregulation leaves the original engine of use fully intact.
Why BPD and addiction are linked
Borderline personality disorder is characterized by intense and unstable emotions, a fragile sense of self, fear of abandonment, impulsive behavior, and difficulty regulating feelings. Several of these features push directly toward substance use:
- Emotional dysregulation. People with BPD experience emotions more intensely and have more trouble calming them. Substances become a way to numb or escape feelings that feel intolerable — the central link between the two conditions.
- Impulsivity. Impulsive behavior is a core BPD trait, and it extends to substance use, making both heavy use and rapid escalation more likely.
- Chronic emptiness and pain. The chronic emptiness and emotional pain common in BPD create a powerful pull toward anything that provides relief.
- Fear of abandonment and relationship turmoil. The intense, unstable relationships of BPD generate frequent emotional crises that can trigger use.
- Shared vulnerability. Trauma, especially childhood trauma, is common in BPD and is also a major risk factor for addiction, giving the two conditions overlapping roots.
Our DBT for addiction guide covers the therapy built specifically for this emotional dysregulation, and our dual diagnosis treatment guide covers treating co-occurring conditions together. The shared role of trauma connects to our EMDR therapy for addiction guide.
Picture this: someone with BPD feels a wave of abandonment after a partner doesn't text back — an emotion so intense and physical it feels like it might actually kill them. There is no tool to ride it out, and a drink or a pill makes it stop almost instantly. Over time, that instant relief becomes the only reliable way to survive the emotional storms, and a substance use disorder takes root on top of the BPD. The use isn't recklessness; it's desperate self-rescue from pain most people never experience at that intensity. That is why treatment has to address the emotion, not just the substance.
How each condition worsens the other
When BPD and addiction occur together, the combination is more severe and dangerous than either alone:
| Effect | What happens |
|---|---|
| More impulsivity | Substances further lower already-impaired impulse control |
| Higher self-harm and suicide risk | The combination markedly raises both risks |
| More intense crises | Use worsens the emotional storms and relationship turmoil |
| Worse treatment engagement | Each condition can derail treatment for the other |
| Faster escalation | Impulsivity and pain drive rapid progression of use |
| Harder diagnosis | Substance effects obscure the BPD picture |
Two points deserve emphasis:
- The safety risk is serious. Both BPD and substance use independently raise the risk of self-harm and suicide, and together that risk climbs substantially. This is a combination to take seriously and treat actively, not wait out. If you or someone you love is in crisis, call or text 988 (the Suicide and Crisis Lifeline).
- They feed each other in a loop. Emotional crises drive use; use worsens emotional stability and relationships; the resulting turmoil drives more use. Breaking that loop requires addressing both ends at once.
Why diagnosis can be complicated
Sorting out BPD and addiction together can be genuinely difficult, which sometimes delays the right treatment:
- Overlapping features. Impulsivity, mood instability, and risky behavior appear in both substance use and BPD, so it can be hard to tell what is driving what.
- Substances mimic symptoms. Intoxication and withdrawal can produce mood swings and impulsivity that look like BPD, while heavy use can mask an underlying BPD.
- Diagnosis often needs time. Clarifying the picture frequently requires a period of reduced use plus a careful history, ideally with a clinician experienced in co-occurring disorders.
- Misdiagnosis is common. BPD is sometimes confused with bipolar disorder (see our bipolar disorder and addiction guide), and adding substance use further muddies the diagnostic water.
Getting the diagnosis right matters because it shapes treatment — and because an accurate, compassionate diagnosis can itself be a relief, helping someone understand that their suffering has a name and an effective treatment.
What integrated treatment looks like
The clear consensus is that BPD and addiction should be treated together, in an integrated way, with therapy specifically suited to emotional dysregulation. The encouraging reality is that effective treatment exists and many people improve significantly.
Key elements:
- DBT (Dialectical Behavior Therapy). DBT was developed specifically for BPD and emotional dysregulation, and a substance-use adaptation directly targets this combination. It teaches concrete skills — distress tolerance, emotion regulation, mindfulness, interpersonal effectiveness — for surviving emotional storms without using. It is the most evidence-based approach for this pairing; see our DBT for addiction guide.
- Integrated, simultaneous care. Both conditions are treated at the same time by a coordinated team, rather than separately or sequentially.
- Addressing trauma. Because trauma so often underlies both, trauma-informed care (including approaches like EMDR) is frequently part of the plan.
- Medication where appropriate. There is no single medication for BPD itself, but medications can help with specific symptoms or co-occurring conditions, and medications for substance use disorders apply as usual.
- Long-term support and skills practice. Recovery from this combination is a process of building and practicing emotional and coping skills over time, supported by therapy and peer support — our relapse prevention strategies guide covers sustaining gains.
Imagine the same person from earlier — the one for whom only substances could stop the emotional storms — now in DBT. They slowly learn distress-tolerance skills that let them survive the wave of abandonment without drinking, and emotion-regulation skills that make the waves less frequent and less overwhelming. As the emotional dysregulation eases, the desperate need for substances eases with it. Treating the shared root, with the therapy built for it, is what finally makes both problems movable. Understanding the brain systems involved, covered in our how addiction affects the brain guide, reinforces why skills-based emotional regulation is so central.
The SAMHSA national helpline (1-800-662-HELP) is free, confidential, and available 24/7 for treatment referrals, including dual-diagnosis programs. Other resources on RehabPulse:
Frequently asked questions
How common is addiction in people with borderline personality disorder? Very common. Studies estimate that up to 78% of people with BPD develop a substance use disorder at some point — one of the highest co-occurrence rates in mental health. The link is driven by the emotional dysregulation, impulsivity, chronic emotional pain, and frequent crises that characterize BPD, all of which push people toward substances as a way to escape feelings that genuinely feel unbearable. Shared roots in trauma also contribute.
Why do people with BPD turn to drugs or alcohol? Most often to regulate emotions that feel intolerable. BPD involves intensely felt, rapidly shifting emotions and deep sensitivity to rejection and abandonment, and substances can provide fast (if destructive) relief from that pain. Impulsivity, a core BPD trait, makes both heavy use and rapid escalation more likely. The use is typically an attempt at self-rescue from extreme emotional distress rather than recklessness or weakness.
Can you treat addiction without treating BPD? No, not effectively. Treating the addiction while leaving BPD's emotional dysregulation unaddressed leaves the main driver of use intact, so relapse is likely. The consensus is that both conditions should be treated together, in an integrated way, ideally with dialectical behavior therapy, which targets the emotional dysregulation underlying both. Addressing the shared root rather than just the substance is what makes lasting progress possible.
What is the best treatment for co-occurring BPD and addiction? Dialectical Behavior Therapy (DBT) is the most evidence-based approach, because it was developed specifically for BPD and emotional dysregulation and has an adaptation for substance use. It teaches concrete skills — distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness — to survive emotional crises without using. Effective treatment also integrates care for both conditions simultaneously, addresses underlying trauma, uses medication where appropriate, and provides long-term support.
Is BPD treatable, and does it get better? Yes. Although BPD was once considered very difficult to treat, the outlook is genuinely hopeful — with appropriate treatment, especially DBT, many people improve substantially, and a significant proportion achieve lasting remission of symptoms over time. When co-occurring addiction is treated alongside it in an integrated way, both conditions can improve together. An accurate, compassionate diagnosis and the right therapy make a major difference.
Sources and references
- National Institute of Mental Health (NIMH). Borderline Personality Disorder. nimh.nih.gov
- National Institute on Drug Abuse (NIDA). Common Comorbidities with Substance Use Disorders. nida.nih.gov
- Substance Abuse and Mental Health Services Administration (SAMHSA). Co-Occurring Disorders. samhsa.gov
- SAMHSA. National Helpline — 1-800-662-HELP (4357), free and confidential 24/7. samhsa.gov/find-help/national-helpline
- National Library of Medicine (MedlinePlus). Borderline personality disorder. medlineplus.gov
- 988 Suicide and Crisis Lifeline. Call or text 988. 988lifeline.org
- SAMHSA. FindTreatment.gov treatment locator. findtreatment.gov
