A Stiff Drink and a Sharp Blade: BPD and Substance Abuse

Yesterday, I told my therapist that all I wanted was "a stiff drink and a sharp blade". As you can imagine, this did not go over well. Yet it made me think--how does substance abuse affect the symptoms of borderline personality disorder (BPD)?

Substance Abuse Often Symptom of BPD

While not always present in people with BPD, substance abuse is a common BPD symptom. It is considered impulsivity in a potentially self-damaging area. Whether it is an illegal street drug or alcohol, substance abuse can damage the user in a myriad of ways.

For example, my drug of choice is alcohol--imported beers to be precise. Alcohol and psychiatric medication are not a good combination. Not only does it make the medication less effective, but it can aggravate the psychiatric symptoms you're taking the medication for. This usually leads to more usage, which magnifies the problem, which leads to more usage... You get the picture. Worse, alcohol on its own can be deadly, and psychiatric medication can prevent you from knowing when you've had enough.

Substance Abuse Can Increase the Likelihood of Self-harm

When you use substances, your judgment is impaired. As a result, the likelihood of self-injury and/or suicide increase considerably.

When I was in college, I was a heavy drinker. This rarely ended happily. I would drink to drown the pain, the flashbacks and self-hatred would start, then I would decide that self-injury was the only way to control it. The result was several crises requiring intervention from a counselor. At one point, a psychologist questioned my ability to handle the demands of college and warned me that continued psychiatric emergencies would force me to withdraw.

A dual diagnosis counselor once told me more of her clients committed suicide than any other therapist at the community mental health center. The reason was because the substance used would aggravate the person's symptoms, increase impulsivity, and impair judgment to the point where the person concluded that it would never get any better. The result was suicide.

The Hope of Sobriety

The good news is it is possible to feel better. There is hope in sobriety.

While it is difficult to give up a drug of choice, it is vital to feeling better. As I said earlier, substance abuse can impair judgment and aggravate symptoms. Remove the substance and you remove this problem. Remove the problem and you will feel better, even if you can't feel it at the time. I know it feels like you've lost your best friend, but it does improve the symptoms. And symptom improvement is worth nearly any price.

There is hope in the midst of chaos. You don't always have to feel the way you feel. The substance is probably making the way you feel worse. Sobriety, therefore, can make you feel better.

Psychiatric treatment, especially when it comes to medication, is as much art than science. There's a lot of educated guessing that goes on. When you're sober, it's easier to tell what drug is causing which reaction, thereby making it easier for the treatment team to determine what to do. When you're using substances, however, it's almost impossible to tell if the medications are working as intended. How do you know the substance use isn't the problem?

It may be tempting to rely on a stiff drink and a sharp blade. However, that usually makes the problem worse. Making it better often involves hard work and is different for each person. Substance abuse is not the answer for BPD symptoms.