Alcohol Use Disorder and Borderline Personality Disorder: How Instability Can Lead to Problematic Drinking

People with BPD have a much higher rate of alcohol dependence and alcohol use disorder, but the research shows they also have a high rate of remission when they use treatment options like naltrexone medication.

What You’ll Learn:

• The common characteristics of borderline personality disorder.

• What the research says about the higher risk of alcohol use for people with BPD.

• Which factors lead to problematic drinking among those with borderline personality disorder.

• Encouraging research that shows people with BPD can achieve remission from AUD.

• Why naltrexone medication can be highly beneficial in achieving and maintaining sobriety.

Instability is the common thread with borderline personality disorder (BPD). Emotional instability, unstable relationships, inconsistent self-image - all of these things can complicate life for a person with BPD.

And those complications increase the risk of developing alcohol use disorder (AUD).

Alcohol use disorder is more common across every personality disorder, not just this one. Our guide to alcohol use disorder and personality disorders breaks down the risk and the research for each one.

Well over half of people with BPD have a lifetime alcohol use disorder risk. That means at some point in their life they are likely to experience AUD. What’s most concerning is that the BPD/AUD link is very strong based on clinical research.

Meta analysis of over a dozen studies found that AUD is an issue for 55.28% of people with borderline personality disorder. Alcohol dependence was found with 44.59% of people with BPD.

These AUD rates for BPD are way higher than the general population.

Given the prevalence, it’s important to understand what it is about borderline personality disorder that makes someone more susceptible to alcohol misuse.

It’s also important to not let the higher rate of alcohol misuse discourage you because research also shows that people with BPD can overcome AUD, especially with naltrexone medication-assisted treatment.

What Are the Common Characteristics of Borderline Personality Disorder?

It’s estimated that up to 2.7% of people have borderline personality disorder. That makes it one of the more common personality disorders, especially among people who drink.

There are nine characteristics associated with borderline personality disorder. They are:

• Frantic efforts to avoid abandonment

• Unstable and intense relationships that swing between idealization and devaluation

• Identity disturbance

• Impulsivity in at least two potentially damaging areas

• Recurrent suicidal behavior or self-harm

• Affective instability

• Chronic emptiness

• Inappropriate intense anger

• Transient stress-related paranoia or dissociation

To meet the clinical definition of border personality disorder a person must have at least five of these characteristics. Living with just one of these traits is a huge burden.

Having to manage five or more of them is overwhelming, which is why many people with BPD have an unhealthy relationship with alcohol.

Years of Research Shows a Strong Link Between AUD and BPD

Just as with narcissistic personality disorder and obsessive compulsive personality disorder, once again NESARC studies provide some of the most in-depth information about alcohol use among people with borderline personality disorder.

In fact, it was one of the research studies that discovered early on that the prevalence of BPD was actually close to even among men and women when it was believed the disorder was more common among women.

Here’s a quick look at what studies have found in regards to the connection between borderline personality disorder and alcohol use:

• NESARC data found that 58.3% of people with lifetime BPD also had lifetime alcohol use disorder, and among people with lifetime AUD, 9.8–14.7% also had BPD.

• A 2024/2025 meta-analysis of 15 studies and over 15,600 people with BPD found AUD prevalence at 55.28%, alcohol dependence specifically at 44.59% and alcohol abuse at 18.84%. With the general population alcohol abuse estimates are approximately 8.6% for men and 1.7% for women.

• A 2013 review came to similar conclusions with 48.8% AUD prevalence among people with BPD, and 14.3% BPD prevalence among people with AUD.

• A more recent review that focused specifically on impulsive/dysregulated personality disorders found a 46–49% AUD prevalence and 59% lifetime AUD prevalence among people with BPD, and a 12–17% BPD prevalence among people with an AUD diagnosis.

The consistency in the findings that people with borderline personality disorder are much more likely to have drinking problems is substantial. Each study validates the findings of the others making the research irrefutable.

Why People With Borderline Personality Disorder Are More Likely to Have Alcohol Use Disorder

There’s a clear connection between BPD and AUD. At least one study has looked specifically at the motives for drinking, and it found that people with BPD largely drink to cope with the symptoms of their disorder.

In other words, it’s coping-oriented drinking.

Understanding the factors that contribute to drinking is essential for understanding what type of support people need to treat both disorders.

Instability + Impulsivity \= Higher Risk of AUD

Borderline personality disorder is a dangerous combination for drinking because instability and impulsivity are two of the most common characteristics. Just one can increase the risk of alcohol misuse, and together it’s even riskier.

Impulsivity is a serious issue with BPD. It’s so prevalent that people with the disorder are impulsive in various areas of their life. They make snap decisions in the moment that are largely based on insatiable emotions and feelings.

Impulsive behaviors such as acting rashly under negative emotion and lack of premeditation lead to problematic alcohol use.

Emotional Dysregulation

People with BPD have intense emotions and emotional reactions that are difficult for them to regulate because they are also vulnerable to feeling invalidated.

Research has found that this is one of the key reasons there’s such a high rate of heavy drinking among people with BPD.

When asked about their motives for drinking, the most common response for people with BPD is blunting unpleasant emotional states. They aren’t doing it out of pleasure or for social reasons.

Drinking is an attempt to handle extreme emotions that are a hallmark for BPD.

Misdiagnosis Can Increase Alcohol Misuse

One of the biggest issues with borderline personality disorder is misdiagnosis. Often BPD is misdiagnosed as bipolar disorder or major depressive disorder.

Some medical experts also believe that men in particular have been historically misdiagnosed with PTSD.

This is a huge disadvantage, because borderline personality disorder is highly treatable when the right evidence-based therapies are used. It’s also a serious issue in terms of drinking since many people with BPD use alcohol to self-medicate.

And unlike the evidence-based therapies, self-medicating with alcohol will only make problems worse.

Why People With BPD Should Be Hopeful About AUD Treatment

The stats for AUD may seem bleak, but there is one very positive finding in the research. People with borderline personality disorder have a very good remission rate when they get help for alcohol use disorder.

A 24-year long study following people with BPD found that the rate of AUD remission was 64-91%.

The one caveat is that relapse was somewhat common at 24-63%. It’s one reason why naltrexone medication can be so beneficial for people with borderline personality disorder.

It’s clinically proven to help curb alcohol cravings and help rewire reward pathways so that it’s easier to drink less or stop drinking entirely. Naltrexone has also been shown to reduce the risk of relapse once a person reaches sobriety.

Choose Your Horizon is a trusted resource for anyone who’s struggling with alcohol use disorder, especially when there are co-occurring disorders like BPD.

We give patients a stress free way to get prescription naltrexone online that’s delivered to your home on a set schedule.

You’ll also have access to therapists that can help address borderline personality disorder for comprehensive treatment that makes day-to-day life easier to manage.

Get started by taking the free Alcohol Use Assessment to get recommendations and schedule a time to speak with a qualified clinician that can help you take control of your drinking.