The Connection Between BPD And Alcohol Explained


Key Takeaways

  • BPD increases the risk of alcohol dependence due to impulsivity and stress.
  • BPD and alcoholism are diagnosed separately but may receive a joint diagnosis.
  • Treatment includes psychosocial interventions for BPD and medication for alcohol use disorder.
  • Therapy and medication-assisted treatment address both BPD and alcohol addiction.

Mental health disorders often go hand-in-hand with substance use disorders.

This usually happens when a person self-medicates using alcohol or drugs to ease symptoms of their mental illness if access to healthcare isn’t available.

Specifically, Borderline Personality Disorder (BPD) can increase the chances of alcohol dependence due to the characteristic impulsivity shown by people living with it.

Alcoholism can also arise when someone uses alcohol as a coping mechanism for life stressors, which is a common occurrence for BPD.

To learn more about what BPD is, the connection between BPD and alcohol consumption, how BPD and alcoholism are diagnosed, and how these conditions are treated, keep reading.

What Is Borderline Personality Disorder?

Borderline personality disorder is a mental illness where people rapidly switch between emotions.

These emotions are intense and individuals with BPD are unable to react normally to stimuli. They show the following traits:


People with BPD act recklessly without considering the consequences.

For example, they may suddenly decide to gamble all their money without considering the financial implications of it.

Or they may drive recklessly and dangerously without any regard for their safety or of those around them

Thinking in extremes

People with BPD tend to think in extremes—there are rarely any gray zones for them.

For example, they may take small criticism as hostility or develop a deep fascination for others who praise them


People with BPD are prone to rapidly changing emotions.

They may quickly switch from friendly to hostile and dislike someone they were just getting along with moments ago.

They can also exhibit sudden bouts of inappropriate anger.

Distorted self-image

Individuals with BPD are inconsistent in maintaining their self-image, which causes them to constantly switch between goals, values, and even careers.

They also experience poor self-esteem because of an unstable perception of themselves


Those who suffer from BPD often feel detached from themselves.

They may have out-of-body experiences where they feel like they are observing themselves from outside their body

What’s the Connection Between BPD and Alcohol Abuse?

Alcohol abuse is common in BPD patients.

In the National Epidemiologic Survey on Alcohol and Related Conditions, 42% of the participants who had a personality disorder also had alcohol dependence. BPD was one of the most common personality disorders in these patients.

Similarly, a 2009 German study looked at more than a thousand hospitalized alcohol-dependent patients.

60% of these patients had a personality disorder, with BPD being one of the most common diagnoses.

There are two factors that encourage excessive alcohol consumption in those with BPD. These include:

Coping mechanism

The stresses of BPD—such as those from strained relationships, workplace problems, a disturbed social life, and uncertainty—may force people to consume alcohol. Alcohol acts as a stress reliever for such patients  


Individuals with BPD are highly likely to engage in binge-drinking activities owing to impulsive tendencies.

They are usually indifferent to the consequences of excessive drinking

    Plus, according to a review, four major causal models have been proposed that link BPD and alcohol. These are:

    The vulnerability model

    This model is also known as the predisposition model. It assumes that the environment and social interactions encourage alcoholism in BPD patients.

    Stressors such as relationship problems and issues at work make an individual with BPD “vulnerable” to the use of alcohol as a way of relieving stress

    Scar model

    Also called the complication model, the scar model assumes that consuming alcohol “scars” an individual by leaving its mark.

    Individuals with BPD have been consuming alcohol for a long time, so their brain adapts to the effects of alcohol (also called neuroadaptation).

    As a result, such individuals feel an increased need to consume more alcohol or maintain their habit

    Exacerbation model

    This model says that BPD alters the manifestation of alcohol use disorder. It affects the onset and pattern of alcoholism in individuals with BPD

    Spectrum model

    This model assumes that BPD and alcohol are caused by similar risk factors. In other words, they both have a similar origin

      Note that there is little reported data to support these models. But based on the information that we have so far, the vulnerability model has the most support.

      Habits of individuals with BPD, like impulsivity and novelty-seeking, make them more likely to develop alcoholism.

      How Are BPD and Alcoholism Diagnosed?

      BPD and alcoholism are usually diagnosed separately. Both conditions have different criteria that healthcare providers use for diagnosis.

      That said, some people might fir the criteria of both disorders, thus receiving a joint diagnosis.

      Borderline Personality Disorder

      According to the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5), BPD is diagnosed when at least five of the following borderline personality disorder symptoms are present in an individual:

      1. Takes steps to avoid abandonment                                                                                        
      2. Has unstable social relationships where they between extreme admiration and hostility                                                                                                        
      3. Has an unstable view of themself                                                
      4. Exhibits impulsivity in at least two domains such as gambling or spending excessive amounts of money                                                                                                                
      5. Has patterns of self-harm or attempts of suicide                                                                                                      
      6. Experiences mood swings such as sudden anxiety or irritability                                                                                                                                        
      7. Feels empty and without purpose                                                                                                                                
      8. Exhibits inappropriate anger                                                                                                                                                      
      9. Experiences dissociation from themself

      Another criterion that the DSM-5 doesn’t mention is called regression proneness, which means the person tends to show emotions and actions not suitable for their age.

      This includes throwing tantrums when confronted or acting too possessive of people and things.

      Some of these BPD symptoms are present in normal individuals as well, which makes the diagnosis the work of only an astute and experienced healthcare provider.

      Alcohol Use Disorder

      There is no specific lab test to diagnose an individual with alcohol use disorder.

      Instead, the diagnosis depends on a patient’s history and drinking habits and is made by a physician using the DSM-5.

      The diagnostic criteria incorporate questions about the effects of alcohol on relationships, health, activities, ability to control their drinking, withdrawal symptoms, and tolerance to alcohol.

      Depending on the number of criteria met, the severity of alcohol addiction is classified as:

      • Two or more: Mild
      • Four to five: Moderate
      • Six or more: Severe

      In some instances, a blood alcohol level may be used for diagnosis. Testing for a chemical called ethyl glucuronide can give an estimate of the blood alcohol level over the past five days.

      How Is BPD and Alcohol Addiction Treated?

      Just like diagnosis, the treatment of BPD and alcohol is done separately.

      But an addiction specialist with experience in treating both conditions will develop a plan that addresses both conditions at the same time.

      Here is what the treatment of each condition consists of:

      Borderline Personality Disorder

      The treatment of BPD is largely through psychosocial interventions.

      Although medical treatments are also available, their efficacy in treating the condition is unclear.


      There are multiple types of therapies available for BPD, including:

      Mentalization-based treatment (MBT)

      MBT focuses on an individual’s ability to develop an understanding of their disease.

      It helps people with BPD develop an understanding of their condition so they are more aware of their behavior and can regulate their emotions.

      MBT is provided as a group therapy or individually  

      Dialectical behavior therapy (DBT)

      DBT is similar to MBT as it also helps people regulate emotions through identification and exhibiting control.

      But it also focuses on developing mindfulness, where individuals with BPD are taught to be completely present in the moment and to observe their surroundings.

      DBT can be provided as group therapy or individually

      Transference-focused psychotherapy (TFP)

      TBP focuses more on interpersonal relationships. It teaches people with BPD to recognize and understand social cues, patterns, and social behavior.

      It uses “transference,” where the individual is asked to remember their past experiences and transfer them to the present, with the therapist as the recipient of those emotions.

      The therapist then dissects these emotional patterns, allowing the patient to understand the problem.

      TFP is only offered as individual therapy

      Schema therapy (ST)

      ST focuses on the emotions, thoughts, and behaviors of an individual with BPD.

      It blends a variety of psychotherapy techniques, such as cognitive behavioral therapy and attachment theory, to instill positive behavior in patients

      Medication for BPD

      There are no guidelines that recommend a drug for the treatment of BPD. But drugs are used off-label for symptomatic management of the condition.

      Serotonin reuptake inhibitors and antipsychotics may be given to lift mood and avoid impulsivity, respectively.

      Alcohol Use Disorder

      Treatment options for alcohol addiction include medication-assisted treatment and behavioral therapy.


      The following medicines are used to treat alcohol use disorder:


      This is the first-line drug for alcohol use disorder. It works by blocking opioid receptors in the brain that cause a person to feel pleasure and reward.

      This eliminates any pleasure derived from drinking alcohol, reducing cravings


      This is another first-line drug for alcoholism but is given to prevent relapse once a person stops drinking.

      The exact mechanism of acamprosate is not known. It is believed to restore the balance between brain neurotransmitters such as GABA and glutamate


      Disulfiram induces unpleasant feelings if a person drinks alcohol along with the drug.

      It inhibits an enzyme called acetaldehyde dehydrogenase, which causes a buildup of acetaldehyde after drinking.

      Acetaldehyde causes flushing, nausea, vomiting, palpitations, and sweating, deterring people from drinking again

      Behavioral Therapy for Alcohol Use Disorder

      Behavioral therapy helps patients understand the harms of alcohol and teaches them strategies to build positive habits.

      It is used side-by-side with medical therapy and can include some of the treatment strategies mentioned above for BPD.

      Community-based groups such as Alcoholics Anonymous also allow patients to sit together and explore their addiction.

      This also helps them find and develop meaningful relationships with other individuals who are motivated to stop using alcohol and are on a similar path to complete sobriety.

      Family therapy can also provide valuable insights to mend broken relationships and set families on the path to healing.

      Get Treatment for Alcohol Dependence at Curednation

      People with BPD are highly likely to develop alcohol dependence.

      If you or someone you love is battling these conditions, seek help from our addiction specialists at Curednation.

      Curednation provides telemedicine addiction treatment services so you can recover where you feel the safest—home.

      Our substance abuse specialists have years of experience treating alcohol use disorders and commonly co-occurring diagnoses, such as BPD.

      Book your appointment today and take the first step in your recovery journey.


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