Alcohol Use Disorder and Borderline Personality Disorder

How Are Alcohol Use Disorder and BPD Connected?

Alcohol use disorder (AUD) is difficulty controlling alcohol use despite meaningful harm or distress, while borderline personality disorder (BPD) is a long-standing pattern involving unstable emotions, sense of self, impulses, and relationships. AUD and BPD are different conditions, but they can occur together and interact. Careful assessment and coordinated treatment matter.^[1][2]

Alcohol Withdrawal Symptoms That Need Emergency Care

In a life-threatening situation, call 911. During possible alcohol withdrawal, go to an emergency department or call 911 for a seizure, fever, severe confusion, hallucinations, or an irregular heartbeat. Severe alcohol withdrawal can become life-threatening.^[3][4]

If someone has been drinking heavily for a prolonged period and plans to stop, seek medical guidance rather than assuming abrupt cessation will be safe. Withdrawal may require monitoring or medication, depending on the person’s history and current symptoms.^[5]

Alcohol Use Disorder and Borderline Personality Disorder Are Distinct Conditions

AUD and BPD may both involve impulsive decisions, emotional distress, relationship conflict, and risky behavior. Those similarities do not make them the same condition, and neither diagnosis can be established from one symptom or one difficult period.

A diagnosis should describe a broader pattern: what happens, how long it has happened, when it occurs, and how it affects health, safety, relationships, work, school, or daily functioning.

Understanding Alcohol Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision defines AUD as a problematic pattern of alcohol use causing clinically significant impairment or distress. A clinician assesses 11 possible symptoms during the previous 12 months. Two or three symptoms indicate mild AUD, four or five moderate AUD, and six or more severe AUD.^[1][8]

Possible symptoms include:

• Drinking more or longer than intended
• Repeatedly trying and struggling to cut down
• Spending substantial time drinking or recovering
• Experiencing strong urges to drink
• Failing to meet important responsibilities because of drinking
• Continuing despite alcohol-related relationship problems
• Giving up important activities
• Drinking in physically hazardous situations
• Continuing despite a physical or psychological problem made worse by alcohol
• Developing tolerance, meaning that more alcohol is needed for the same effect
• Experiencing withdrawal—symptoms after stopping or reducing sustained heavy drinking—or drinking to relieve those symptoms^[8][4]

AUD is not defined by a particular beverage, drinking frequency, or single episode. Heavy drinking can increase risk without necessarily meeting AUD criteria, while someone who does not drink every day may still have AUD if the diagnostic pattern is present. AUD is a medical condition, not a character flaw.^[5]

Understanding Borderline Personality Disorder

BPD affects mood and how a person experiences themselves and relates to others.

Its features can be grouped into:

• Emotions: Emotional instability
• Thinking and perception: Disturbed thinking or perception
• Behavior: Impulsive behavior
• Relationships: Intense but unstable relationships

Symptoms usually emerge during adolescence and persist into adulthood, although their severity and course can change.^[2]

Features considered during assessment may include:

• Intense efforts to avoid real or perceived abandonment
• Unstable or sharply changing relationships
• An unstable sense of identity
• Impulsive or dangerous behavior
• Recurrent suicidal behavior or self-injury
• Rapid emotional shifts
• Persistent feelings of emptiness
• Intense anger or difficulty managing it
• Stress-related paranoid thoughts or dissociation, such as feeling disconnected from oneself or one’s surroundings^[9][10]

These features exist on a spectrum. Having mood swings, fearing rejection, acting impulsively, or self-harming does not by itself establish BPD. Diagnosis requires a persistent, impairing pattern assessed in context.

Comparing Alcohol Use Disorder and Borderline Personality Disorder

The treatment comparison reflects broader guidance, not proof that every person needs every listed option. Care should be matched to symptoms, goals, medical needs, and practical circumstances.^[5][11]

Distinguishing BPD and Alcohol Use Disorder From Other Conditions

BPD can resemble several other conditions because its symptoms and clinical features overlap with other diagnostic categories. Differential diagnosis means distinguishing among conditions that can look similar but may need different treatment.^[12]

Distinguishing Bipolar Disorders From BPD

BPD is particularly important to distinguish from bipolar spectrum disorders. A clinician examines the timing and pattern of affective instability, meaning changes in emotional state, and evaluates for hypomania.^[12]

Bipolar disorder involves episodes of marked changes in mood and activity. Mania is an unusually elevated or irritable mood with increased activity; hypomania is a less severe form that interferes less with daily life. Depressive episodes may also occur. These terms describe more than an ordinary passing “mood swing.”^[13]

Depression, Trauma, and Anxiety in a BPD and Alcohol Assessment

BPD may resemble major depression or post-traumatic stress disorder, and anxiety disorders may occur alongside BPD. A diagnosis requires assessing the pattern over time, not choosing a label from one shared symptom.^[12][2]

Major depression involves persistent symptoms that include depressed mood or loss of interest or pleasure. For diagnosis, symptoms occur most of the day, nearly every day, for at least two weeks and affect functioning. This sustained pattern needs assessment alongside any difficulties with identity, impulses, or relationships.^[14][2]

Post-traumatic stress disorder (PTSD) can develop after trauma. Its features include re-experiencing the event through memories or nightmares, avoiding reminders, feeling unusually alert or reactive, and changes in thoughts or mood. The connection to trauma is part of the assessment; having experienced trauma does not by itself establish PTSD.^[15]

Anxiety disorders are another possibility. For example, generalized anxiety disorder involves excessive, difficult-to-control worry about everyday concerns, often accompanied by tension, restlessness, or sleep problems. It is more than occasional nervousness. Such symptoms can require care even when BPD is also present.^[16][2]

When alcohol use is involved, assessment also considers whether emotional symptoms remain after withdrawal or detoxification, using information about prior functioning when available.^[17]

Considering ADHD and Schizophrenia During Assessment for BPD

Attention-deficit/hyperactivity disorder (ADHD) involves persistent difficulty paying attention, hyperactivity, impulsivity, or a combination. Its symptoms begin in childhood and interfere across everyday settings. Developmental history therefore matters; impulsivity alone cannot distinguish ADHD from BPD.^[18][12]

Schizophrenia can involve psychosis, meaning changes in how someone experiences reality. Examples include hallucinations—perceiving things that are not there—and delusions, strongly held beliefs that are not objectively true. It may also affect thinking, motivation, and everyday functioning.^[19]

BPD may be confused with schizophrenia, but these brief descriptions are not a diagnostic checklist. Clinicians consider the full pattern and course because overlapping features can have different explanations and may require different treatments.^[12]

Alcohol Dependence and Alcohol Withdrawal

Older research may use alcohol abuse and alcohol dependence, separate diagnoses from an earlier diagnostic manual. Current U.S. practice combines relevant symptoms into AUD and grades it as mild, moderate, or severe. Therefore, findings about alcohol dependence should not automatically be treated as findings about every level of current AUD.^[17]

Alcohol withdrawal is also not the same as AUD, although it may be one feature. Withdrawal can occur when someone who has regularly been drinking too much suddenly stops. Symptoms can include anxiety, irritability, poor sleep, nausea, sweating, tremor, rapid heart rate, hallucinations, or seizures.^[4]

How Often BPD and Alcohol Use Disorder Co-Occur Depends on Who Is Studied

Earlier research summarized in a study of everyday drinking reports that approximately half of people with BPD meet criteria for AUD and about 15% of people with AUD meet criteria for BPD. In practical terms, the overlap looks larger when researchers begin with a BPD population than when they begin with an AUD population.^[6]

These figures should be read as broad estimates, not personal probabilities. Older studies may assess alcohol dependence rather than the current AUD spectrum, so their findings should not automatically be applied to every level of current AUD.^[17]

BPD itself is identified more often in psychiatric settings than in general-population samples. One systematic review cited estimates of 1.8% in the general population, 10% among psychiatric outpatients, and 15% to 25% among psychiatric inpatients. Those setting differences help explain why estimates from specialty care should not be generalized directly to every community.^[7]

Alcohol Use and Borderline Symptoms May Reinforce One Another

Several supported explanations may help make sense of the overlap. None establishes a single cause, and different pathways may apply to different people.

Difficulty Regulating Emotions May Link BPD and Alcohol Use

Emotion regulation is the ability to notice, tolerate, and respond to emotions without being driven automatically by them. Someone may drink to increase pleasant feelings, dampen distress, escape emptiness, or cope with conflict. If alcohol provides brief relief, that immediate reward can make the behavior more likely to recur.

Research links using alcohol to cope with negative emotions to the relationship between traits such as impulsivity or emotional sensitivity and reported alcohol problems. This supports emotion regulation as one plausible shared process, but it does not prove that BPD causes AUD or that coping is everyone’s reason for drinking.^[17]

Drinking Speed and Amount May Matter in BPD

A daily-life study compared 54 adults with BPD and 59 community participants, all ages 18 to 45, who reported at least one drinking episode per week on average over the past month. The BPD group’s estimated blood alcohol concentration—the amount of alcohol in the bloodstream—increased faster during drinking episodes.^[6]

Faster consumption was associated with feeling stimulated in both groups, while stimulation was linked to increased positive mood in both groups and reduced negative mood in the BPD group.^[6]

The practical point is that two people consuming a similar total amount may have different patterns and immediate experiences. Questions about speed, setting, emotion, and consequences can reveal information that drink counts alone miss.

The study cannot show that BPD caused faster drinking. It used a nonrepresentative, mostly female sample, relied on self-reported drinks to estimate blood alcohol concentration, and excluded people with physiological withdrawal, unsuccessful attempts to stop in the previous year, or interest in AUD treatment. Other co-occurring disorders were also more prevalent in the BPD group.^[6]

BPD and Alcohol Use Disorder May Share Vulnerabilities

Impulsivity, difficulty tolerating distress, sensitivity to reward, environmental stress, and other genetic or developmental factors could contribute to both conditions. AUD vulnerability itself reflects a combination of genetic and environmental influences, while the causes of BPD also appear multifactorial.^[1][2]

Research has not established one universal sequence. AUD may develop before BPD is recognized, BPD symptoms may precede problematic drinking, or the two patterns may become apparent around the same time.

An Example of How Emotional Distress and Drinking Can Interact

A person feels rejected after a difficult conversation and quickly drinks several drinks to escape intense distress. Alcohol briefly changes the emotion but later contributes to impulsive messages, conflict, and shame, which trigger another urge to drink.

This invented example illustrates a possible reinforcing cycle, not a real patient or a proven pattern for everyone. Treatment could target several points in the cycle: identifying the trigger, slowing action, tolerating distress, changing drinking behavior, repairing relationships, and planning for the next high-risk moment.

Assessing Persistent BPD Symptoms Separately From Alcohol Effects

A thorough evaluation looks at both conditions together while preserving their differences. It should not assume that every emotional symptom comes from BPD or that every difficulty is alcohol-induced.

What an Assessment for BPD and Alcohol Use Disorder May Cover

An evaluation commonly explores:

• The amount, frequency, speed, and setting of alcohol use
• AUD symptoms during the previous 12 months
• Intoxication, blackouts, tolerance, and withdrawal
• Past attempts to reduce or stop drinking
• Emotional, identity, relationship, and impulse-control patterns
• When symptoms began and whether they occur when not drinking
• Depression, anxiety, trauma symptoms, bipolar symptoms, psychosis, eating problems, and other substance use
• Physical health, medications, sleep, safety, daily functioning, and current supports

Brief alcohol screeners can identify unhealthy use, but a positive screen is not itself an AUD diagnosis. An 11-item symptom checklist based on current criteria can help determine whether AUD is present and estimate severity.^[8]

Why the Timing of Symptoms and Alcohol Use Matters

Heavy alcohol use or withdrawal may be associated with irritability, anxiety, or low mood. Withdrawal can also involve sleep difficulty, mood swings, and not thinking clearly. Withdrawal symptoms often begin within eight hours of the last drink, may arise days later, and commonly peak around 24 to 72 hours, although some symptoms can last longer.^[17][4]

When alcohol effects could explain the presentation, clinicians may need information from more than one point in time. A review of co-occurring AUD and personality disorders notes that assessment after withdrawal or detoxification may help determine whether irritability, anxiety, or low mood resolves and was substance-induced. Information about functioning before heavy alcohol use can also help.^[17]

This does not mean that someone must complete treatment or achieve prolonged abstinence before receiving mental health help. Immediate safety, withdrawal, and distress still require attention. It means that a diagnosis made during intoxication, withdrawal, or crisis may need thoughtful review when the person is medically stable. United Kingdom guidance similarly recommends reviewing diagnoses made during emergency or crisis presentations.^[11]

Preparing for a BPD and Alcohol Use Evaluation

It may help to bring a brief timeline showing:

• When emotional and relationship difficulties began
• Periods of heavier, lighter, or no alcohol use
• What happened before and after important episodes
• Previous diagnoses and treatments
• Withdrawal symptoms or seizures
• Current prescriptions, over-the-counter medicines, and other substances
• Recent self-harm, suicidal thoughts, aggression, or unsafe behavior

A timeline supports assessment without requiring you to diagnose yourself. If memory is difficult, use approximate dates rather than abandoning the task.

Treating BPD and Alcohol Use Disorder Together

Co-occurring care does not necessarily mean one program or one therapist provides everything. It means the plans are compatible, responsibilities are clear, and progress in one area is not assessed without considering the other.

Care intensity may change over time. Outpatient care means attending appointments without staying overnight; telehealth provides care remotely. Intensive outpatient care and partial hospitalization offer more coordinated outpatient support. Residential treatment provides a 24-hour treatment setting, while inpatient care provides medically directed 24-hour services.^[5]

More expensive or restrictive care is not automatically better; assessment should guide the setting.^[20]

Psychotherapy for Borderline Personality Disorder

Psychotherapy is the foundation of BPD treatment. A systematic review included 25 studies and 2,545 participants aged 13 or older. Both treatment as usual—the routine care used for comparison—and the studied psychotherapies improved BPD severity and symptoms. Evidence favored several structured approaches over treatment as usual, but its certainty varied, and head-to-head studies did not establish that one psychotherapy was superior to the others.^[7]

That means a recognizable treatment name matters less than finding structured care that:

• Has a clear therapeutic approach
• Targets the person’s main problems and goals
• Monitors BPD symptoms, alcohol use, self-harm, and functioning
• Includes consistent expectations and crisis planning
• Is delivered by someone trained in the approach
• Can coordinate with alcohol and medical care

United Kingdom guidance recommends structured psychological treatment and advises against very brief interventions of less than three months as stand-alone treatment specifically for BPD. This is jurisdiction-specific guidance, but it reflects the broader point that meaningful personality-focused therapy commonly requires continuity.^[11]

Dialectical Behavior Therapy for BPD

Dialectical behavior therapy (DBT) is a structured form of cognitive-behavioral treatment developed for BPD. Cognitive-behavioral approaches help people identify and change unhelpful beliefs and behaviors. Comprehensive DBT traditionally includes individual therapy, group skills training, between-session coaching, and a therapist consultation team. Its skills focus on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.^[9][10]

These skills are relevant when alcohol use follows intense emotion or impulsive action. Mindfulness helps a person notice an urge before acting. Distress tolerance offers ways to survive a crisis without making it worse. Emotion regulation addresses vulnerability and emotional escalation. Interpersonal effectiveness supports clearer requests, limits, and conflict management.

Evidence specifically involving both BPD and substance problems is encouraging but mixed. A randomized trial—one that assigned participants to treatments by chance—enrolled 101 women with BPD and recent, repeated suicidal or self-injurious behavior.^[21]

One year of DBT produced better outcomes for remission, meaning no longer meeting criteria for a disorder, and more alcohol- and drug-abstinent days than community treatment by psychotherapy experts. The study addressed substance dependence broadly, including substances other than alcohol, not AUD alone.^[21]

A broader review reported other studies in which DBT improved BPD symptoms similarly in participants with and without a substance use disorder, but did not outperform treatment as usual for substance-related symptoms. Another trial involving men found little substantial change in alcohol or substance use.^[17]

The balanced conclusion is that DBT can be a strong BPD treatment and may support substance-related improvement for some groups, but DBT alone should not be assumed to treat every form or severity of AUD.

Other Psychotherapies for BPD

Several other structured psychotherapies have been studied for BPD.

Their names describe different ways of working:

• Schema therapy works on entrenched patterns of beliefs and responses, often learned early in life, and whether they still fit a person’s current circumstances.^[22]
• Mentalization-based treatment helps people examine their own thoughts and feelings, consider other people’s perspectives, and question assumptions about what others mean.^[23]
• Transference-focused psychotherapy examines relationship patterns as they emerge between the person and therapist.^[22]
• Systems Training for Emotional Predictability and Problem Solving (STEPPS) teaches emotion-management and behavioral skills, with involvement from supportive people, alongside other treatment.^[22]

Broader BPD evidence supports several approaches, but direct comparisons remain limited. These descriptions explain the methods; they do not establish which one works best for someone with both BPD and AUD.^[7]

Evidence specific to co-occurring BPD and AUD is much smaller. An integrated schema therapy case series—a report following a group receiving treatment—enrolled 20 people, with 17 participating in a one-year follow-up. Improvements in BPD and AUD symptoms were generally maintained, but the study did not include a randomized comparison group. A randomized trial is needed before attributing those improvements confidently to the therapy.^[24]

Behavioral Treatment for Alcohol Use Disorder

Alcohol-focused behavioral treatments aim to change drinking and strengthen recovery skills. Options include cognitive-behavioral therapy, mindfulness-based treatment, and couples or family therapy.

Other approaches include:

• Motivational enhancement, which helps a person build their own reasons, plan, and confidence for changing their drinking.
• Contingency management, which uses tangible rewards for meeting specific treatment goals, such as attending sessions or not drinking.
• 12-step facilitation, which is professional support to help someone participate in a 12-step mutual-support group, such as Alcoholics Anonymous.^[25]

Treatment may work on:

• Understanding drinking patterns and consequences
• Clarifying personally meaningful goals
• Managing stress and negative moods
• Handling urges
• Practicing drink-refusal skills
• Planning for high-risk people, places, and situations
• Responding constructively to a return to drinking

Mutual-support groups may add flexible peer support to professional treatment. Options include 12-step and secular approaches, and no single format suits everyone.^[5]

Medication for Alcohol Use Disorder

Three medications are approved in the United States to help adults stop or reduce drinking and prevent a return to drinking:

These medications are nonaddictive and may be used alone or with counseling. Broader AUD guidance also identifies gabapentin and topiramate as possible second-line options in selected circumstances, although they are not approved by the Food and Drug Administration specifically for AUD.^[25][1][5]

The research discussed here does not establish that one AUD medication works best specifically for people with both AUD and BPD. A prescriber should consider diagnosed co-occurring conditions, treatment goals, current and previous treatments or medicines, potential harms including overdose risk, and alcohol or other substance use when discussing options.^[5][11]

Medication for Borderline Personality Disorder

Medication should not be treated as a substitute for BPD psychotherapy. Evidence for medicines targeting BPD itself is mixed and often nonspecific. Medicines may sometimes be used for a separate co-occurring condition, but improvement in depression or anxiety does not necessarily mean the underlying BPD pattern has improved.^[9]

United Kingdom guidance advises against using medication specifically for BPD or its individual behaviors and symptoms, and against medium- or long-term antipsychotic medication—medicines used to treat psychotic symptoms—for BPD. It allows medication to be considered for diagnosed co-occurring conditions. U.S. decisions may follow different guidelines, but the distinction remains important: treating AUD, depression, or another condition is not the same as treating BPD itself.^[11]

Benefits and Limits of Treatment for Co-Occurring BPD and Alcohol Use Disorder

For BPD in general, structured psychotherapy can improve symptoms, severity, and functioning, and recovery is possible. Available evidence does not strongly establish one psychotherapy as best for everyone.^[7][11]

For AUD in general, behavioral treatment, medication, and mutual support can help people stop or reduce drinking and experience fewer alcohol-related problems. Treatment often requires adjustment over time rather than one decisive episode of care.^[5]

Evidence for people who specifically have both BPD and AUD is less developed. Many studies combine alcohol with other substance disorders, enroll small or narrowly defined groups, or lack randomized comparison conditions. Findings from suicidal women, treatment-seeking participants, or people with alcohol dependence cannot automatically be generalized to every gender, risk level, or AUD severity.

Remaining engaged can also be difficult. A review reported treatment attrition, or dropout, of 40% in one BPD and substance use disorder sample and described some evidence of higher dropout among people with AUD and a personality disorder than among those with AUD alone. A strong therapeutic relationship and clear expectations may support retention, but more research on dual-diagnosis treatment is needed.^[17]

Missing appointments or returning to alcohol does not prove that treatment cannot work. AUD recovery may include setbacks, learning, and renewed engagement. Regular follow-up lets the plan change as needs change.^[5]

Practical Skills for Stability With BPD and Alcohol Use Disorder

Formal treatment is central, but small daily actions can make high-intensity moments more manageable. Choose one or two strategies rather than trying to transform everything at once.

Tracking Emotional Distress, Urges, and Drinking Patterns

Briefly record:

• What happened before the urge or emotional shift
• The emotion and its intensity
• Whether, how quickly, and how much you drank
• What happened immediately afterward
• What happened the next day
• Which alternative response helped, even slightly

The goal is not perfect recordkeeping. It is to identify patterns that can guide treatment, such as drinking after conflict, during loneliness, or while feeling unusually energized.

Putting Time Between a Drinking Urge and an Action

Possible delay strategies include:

• Leaving the immediate setting
• Contacting a chosen support
• Taking a shower or eating
• Walking in a safer place
• Practicing a previously learned grounding skill, such as focusing attention on the present moment

A delay does not need to erase the urge to be useful; it creates time for another choice.

If distraction or self-management is not enough, follow the professional or crisis plan you have established. A useful crisis plan identifies triggers, strategies that have helped before, and the services or people to contact when those strategies are insufficient.^[11]

Planning Transitions Between BPD and Alcohol Treatment Services

Changes of therapist, program, medication plan, or care setting may evoke strong emotions for someone with BPD. Discuss endings early, request a written transition plan, and clarify who will respond during gaps in care. Guidance for BPD specifically recommends anticipating emotional reactions to treatment endings and service transitions.^[11]

Coordinating a Care Plan for BPD and Alcohol Use Disorder

When several providers are involved, ask for a plan that states:

• Who is treating AUD
• Who is providing BPD-focused therapy
• Who manages medications and physical health
• How providers may communicate with consent
• Which outcomes will be tracked
• What to do if alcohol use, self-harm, or suicidal thoughts increase
• How to re-enter care after missed appointments or a setback

Clear roles reduce the risk that each provider assumes someone else is managing an important need.

Supporting a Loved One With BPD and Alcohol Use Disorder

Supporting someone with AUD and BPD can involve intense emotions and uncertainty. When offering support, focus on specific behaviors and safety concerns, use nonstigmatizing language, and choose limits you can realistically keep. AUD is a medical condition rather than a character flaw, and stigma can discourage help-seeking.^[5][11]

You might describe a specific concern rather than assigning a motive:

“I’m worried because you drove after drinking.”

Illustrative conversation.

A boundary can describe your own action, such as:

• Not riding with someone who has been drinking
• Ending a conversation that becomes threatening
• Not providing money that may be used for alcohol

During a highly emotional moment, you can use short, calm statements that acknowledge distress without agreeing with unsafe behavior. For example: “I can hear that this is overwhelming. I will stay while we contact help, but I cannot keep this secret if you may be in immediate danger.”

If you can, offer specific, limited help, such as sitting with the person while they call a provider, helping compare programs, or providing transportation to an appointment. It is also reasonable to be clear about help you cannot provide. If immediate danger is possible, contact appropriate emergency or crisis help.

When BPD or Alcohol-Related Symptoms Need Urgent Help

In a life-threatening situation, call 911. During possible alcohol withdrawal, go to an emergency department or call 911 for a seizure, fever, severe confusion, hallucinations, or an irregular heartbeat. Severe alcohol withdrawal can become life-threatening.^[3][4]

In the United States, call or text 988 or use 988 chat for 24-hour, judgment-free support related to suicidal crisis, emotional distress, or substance use. Spanish and Deaf or hard-of-hearing access are available. You may also contact 988 if you are worried about someone else.^[26]

Choosing Ongoing Care for BPD and Alcohol Use Disorder

A primary care or mental health clinician can be a starting point even if integrated specialty care is unavailable. AUD treatment can also be delivered through outpatient visits and telehealth, and some people require more intensive settings.^[20][5]

When comparing providers or programs, ask:

• Do you assess and treat both substance use and mental health conditions?
• How do you distinguish BPD symptoms from intoxication, withdrawal, bipolar disorder, trauma, or depression?
• Which structured psychotherapy do you provide, and what training supports it?
• Does your program offer comprehensive DBT or only a DBT-informed skills group?
• How will alcohol goals and BPD symptoms be monitored together?
• Are AUD medications available or coordinated with another prescriber?
• How do you handle missed sessions, a return to drinking, self-harm risk, and crises?
• How will you coordinate with my other providers?
• What are the expected costs, schedule, and duration?
• How are treatment changes and endings planned?

The National Institute on Alcohol Abuse and Alcoholism Alcohol Treatment Navigator is a noncommercial U.S. resource for comparing evidence-based alcohol care, including programs, therapists, and physicians. It emphasizes searching trusted sources, asking quality questions, and selecting care based on individual needs rather than price alone.^[20]

Next Steps for Getting Help With BPD and Alcohol Use Disorder

Choose a next step that fits what is happening now:

• If you are gathering information, write down the symptoms or situations that concern you, when they occur, and how alcohol changes them. Avoid assigning yourself or another person a diagnosis from a checklist.

• If alcohol or emotional symptoms are affecting daily life, request an assessment that covers both alcohol use and mental health. Ask the evaluator to consider symptom timing, withdrawal, other possible diagnoses, and a follow-up plan if symptoms or needs change.

• If you already have one diagnosis, ask whether the other condition has been assessed rather than assumed. Bring a medication list and mention withdrawal symptoms, blackouts, self-harm, suicidal thoughts, and other substance use directly.

• If you are entering treatment, choose one manageable action: schedule an evaluation, ask about structured psychotherapy, discuss alcohol treatment options, or create a written crisis plan. Care may involve more than one provider or setting, and a single well-chosen first appointment can begin the process.

• If danger is immediate, use emergency services. For suicidal crisis, emotional distress, or urgent substance-use support in the United States, call or text 988.^[3][26]