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Research Proposal

Jessica C. Paone
University of Phoenix
PSYCH/610
April 19, 2021
Dr. Nancy Walker
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ABSTRACT

This study will discuss the relationship between Borderline Personality Disorder (BPD)

and Substance Use Disorder (SUD). Borderline Personality Disorder is a mental health

condition that is often misunderstood by society. It affects an individual’s ability to maintain

healthy relationships. Individuals with BPD are often seen as being manipulative and dramatic.

Because of the emotional pain that individuals with BPD are in, they are at a greater risk for

suffering from SUD. Individuals with BPD will often try to number their emotional pain by

turning to drugs and alcohol.

The more we learn about mental health conditions, the better we will understand how

mental health plays a role in individuals who develop Substance Use Disorder. When we can

treat the underlying mental health issue, we will better treat the substance use issue. If we

address the substance abuse, but not the pain that contributed to the original use of the substance,

the individual will return to what helps them cope.

The participants in the research study are both male and female. They are located in an inpatient

treatment center. They have prior inpatient rehab center stays that we can track to see if they

continued with mental health treatment after their previous inpatient stay. We are using

anonymous surveys to conduct our research. The study is also utilizing The McLean

Screening Instrument for Borderline Personality Disorder. The study consists of 10 male

participants and ten female participants between the ages of 22-40. The hypothesis for this study

is approximately 50% of individuals with Substance Use Disorder also have been diagnosed with

Borderline Personality Disorder previously or have undiagnosed Borderline Personality

Disorder.
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Introduction

Substance Use has continued to skyrocket through the United States over the last few

decades. In 2019, over 70,000 Americans died from a drug overdose. According to the National

Survey on Drug Use and Health, more than 45% of individuals with a SUD issue also have a

dual diagnosis. Dual Diagnosis is when an individual has both a mental health condition and a

substance use issue. The reason for conducting this study is to research the relationship between

BPD and SUD. Individuals with an initial diagnosis of BPD and SUD were twice as likely to be

diagnosed with BPD on follow-up visits than those with BPD only (Link, 2005). The following

questions will help gather information to be utilized in the study and help analyze the connection

between individuals with BPD and co-occurring SUD.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is often called

the DSM 5 or the DSM-V, is the latest version of the American Psychiatric Associations, the

gold standard of names and definitions of every diagnosable mental health disorder. The DSM 5

criteria for Substance Use Disorders are based on decades worth of research. The DSM 5 was

published in 2013, nearly 20 years after its predecessor, the DSM 4, published in 1994. There

are ten separate classifications of drugs that can lead to a substance use disorder according to the

DSM 5. Those classes are alcohol, caffeine, cannabis, hallucinogens (including LSD and

phencyclidine), inhalants, opioids, sedatives and hypnotics, stimulants (including amphetamines

and cocaine), tobacco, and other known substances.

There are two different groups of substance-related disorders; there are substance use-

related disorders and substance-induced related disorders. Substance Use disorders are the result

of using a substance that you continue to take, even after experiencing negative results.
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Substance-induced disorders include being intoxicated, withdrawal, and other substance or

medication-induced mental disorders.

There are 11 different criteria for an individual to be diagnosed with a substance use

disorder (APA, 2013). They are as follows:

1. Taking the substance in larger amounts or for longer than you're meant to.

2. Wanting to cut down or stop using the substance but not managing to.

3. Spending a lot of time getting, using, or recovering from the use of the substance.

4. Cravings and urges to use the substance.

5. Not managing to do what you should at work, home, or school because of substance

use.

6. Continuing to use, even when it causes problems in relationships.

7. Giving up important social, occupational, or recreational activities because of

substance use.

8. Using substances again and again, even when it puts you in danger.

9. Continuing to use, even when you know you have a physical or psychological

problem that could have been caused or made worse by the substance.

10. Needing more of the substance to get the effect you want (tolerance).

11. Development of withdrawal symptoms, which can be relieved by taking more of the

substance.

The DSM 5 also helps clinicians to classify the severity of the SUD. If an individual has

two to three symptoms, the individual is considered to have a mild substance use disorder. If an

individual has four or five symptoms, then the individual is deemed to have a moderate
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substance abuse disorder. And finally, if the individual has six or more of these symptoms, then

the individual is considered to have a severe substance use disorder.

The term co-occurring disorder refers to a condition in which an individual has both a

mental health condition as well as a substance use disorder. Individuals who have a co-occurring

disorder, may experience differences in the severity of their disorders overtime. These

individuals may need longer periods in treatment to address both the mental health issue as well

as the substance abuse issue. Individuals with co-occurring disorders may be more prone to

symptomatic relapses, hospitalizations, family issues, physical violence, and incarceration.

The causes of these disorders may vary; some individuals are genetically predisposed to

mental health disorders and substance use disorders, other's environment may play a role in the

development of these disorders.

Individuals with a dual drug and alcohol use disorder are the most likely to suffer from a

personality disorder, with an approximate percentage of 51% having a personality disorder.

While individuals with a drug use disorder, 44% of those individuals also have a personality

disorder. And individuals with an alcohol disorder 25% of those individuals also have a

personality disorder.

In order to help identify if an individual has a co-occurring disorder, we have developed

the following questions.

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Questions

1. What is your Drug of Choice

2. How long have you been using

3. What was your age of first use

4. Do you have a mental health diagnosis/What is the Diagnosis

5. Have you ever been hospitalized for your mental health

6. Do you have a history of suicidal ideation or suicide attempts

7. Have you previously self-harmed, for examples burning or cutting

8. Have you experienced trauma

9. Do you have a history of abuse (Physical, Mental, Sexual)

10. Do you have a history of violent behavior

11. Family History Psych

12. Family History Substances

13. Longest period of sobriety

14. Do you take medication

15. Have you continued mental health treatment after substance abuse treatment

16. What were your barriers to continue treatment

17. What do you consider to be your primary ailment Mental Health or Substance Use

18. Do you have support for your mental health/substance use recovery

19. Do you feel you have people that you can trust in your life
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The Research Methodology

The research design that will be utilized in this study is a qualitative research design. We

will be utilizing questionnaires as well as utilizing case studies in order to conduct our research.

To begin the study, participants will be asked to be interviewed; then we will be using data

analysis to study the results of the questions asked during the interview. This data will assist the

researchers in being able to verify the findings of the study. The discussions and questions asked

will be done individually.

Sampling

The individuals that will be used for this study will be located in inpatient treatment

centers for Drug and Alcohol abuse. The inpatient treatment centers will be co-occurring

treatment centers that can treat both mental health and substance use concurrently. The

individuals in this study will be between the ages of 22 and 40. They will consist of 10 men and

10 women respectively.

The Data Collection

The interviews in this study will all be recorded. This will be vital to the study to ensure

that all information has been properly documented and all answers to the questions during the

interview have been categorized as intended. Privacy and confidentiality will be essential, and

all individuals will have signed informed consent stating that they are aware that the results are

being used for research intent.

Literature Review

Borderline Personality disorder (BPD) is a personality disorder that is often severe. It

primarily develops by early adulthood. The primary symptoms of this disorder are poor

emotional regulation, acting impulsively, and having difficulty building relationships; finally,
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individuals with BPD have suicidal and self-harming behaviors (APA, 2013). BPD is one of the

most diagnosed personality disorders in both inpatient treatment centers as well as individuals

who are being seen in outpatient offices. Individuals who have been previously diagnosed with

BPD are often individuals that suffer from another mental health condition as well and are

known to attempt suicide, seek and utilize healthcare services, and often have difficulty in their

relationships, as well as functioning in society. BPD can be thought of as nonadaptive variants

of general personality traits from the Five-Factor Model, primarily represented by high

neuroticism, antagonism, and disinhibition (Saulsman, 2004).

Chronic or excessive use of substances can be potential indicators of a co-occurring

disorder involving BPD. Often, in individuals who have co-occurring disorders of BPD and

SUD, there are underlying factors that may contribute to both of the disorders. They may

include but are not limited to Childhood Trauma, including physical abuse, sexual abuse as well

as emotional abuse. Or the individual may have a genetic predisposition to either BPD or SUD.

Not having the ability to apply emotional regulation, as well as an individual being

impulsive, are prominent in both disorders (Littlefield, 2016). For example, one of the criteria

for BPD is a chronic feeling of emptiness, not having a stable affect, and having problems with

anger. The significant theories regarding SUD involve the same issues regarding emotional

regulation as being a primary role of severe substance use and issues that are associated with

substance use. The use of substances is often a way for the individual to stiffen their responses

to negative emotions, often through a negative reinforcement process. This often becomes a way

that the individual copes with their negative effect (Cooper, 2016). Impulsivity which is

prevalent in both conditions and is one of the significant personality features of an individual

with BPD, can often lead to negative consequences, including but not limited to substance abuse
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as well as dependence. Similar studies involving SUD and the development of SUD also involve

impulsivity, especially in the early stages of addiction (Litten, 2015).

Discussion

This study is being conducted to show the relation between the mental health condition of

Borderline Personality Disorder and Substance Use Disorders. This study will show that there is

a high correlation relationship between the two disorders. This study will also show whether

borderline is more prevalent in males or females. The treatment that the individual needs in order

to be able to address both disorders concurrently can be affected by this study, including

adapting both Cognitive Behavioral Therapy approaches as well as Dialectical Behavioral

Therapies to the individual who has BPD while in treatment for SUD. Not all approaches are

appropriate for all individuals, and this study showing the relationship between the two disorders

will help treatment centers become better equipped to treat borderline individuals.
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References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.

Arlington: American Psychiatric Publishing; 2013.

Bornovalova, M. A., Lejuez, C. W., Daughters, S. B., Rosenthal, M. Z., & Lynch, T. R. (2005).

Impulsivity as a common process across borderline personality and substance use

disorders. Clinical psychology review, 25(6), 790-812.

Cooper ML, Kuntsche E, Levitt A, Barber LL, Wolf S. Motivational models of substance use: a

review of theory and research on motives for using alcohol, marijuana, and tobacco. In:

Sher KJ, editor. The Oxford handbook of substance use disorders, vol. 1. New York:

Oxford; 2016. p. 375–421.

Flynn, P. M., & Brown, B. S. (2008). Co-occurring disorders in substance abuse treatment:

Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36-47. doi:

10.1016/j.jsat.2006.11.01

Links, P. S., Heslegrave, R. J., Mitton, J. E., Van Reekum, R., & Patrick, J. (1995). Borderline

personality disorder and substance abuse: Consequences of comorbidity. The Canadian

Journal of Psychiatry, 40(1), 9-14.

Litten RZ, Ryan ML, Falk DE, Reilly M, Fertig JB, Koob GF. Heterogeneity of alcohol use

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Littlefield AK, Sher KJ. Personality and substance use disorders. In: Sher KJ, editor. Oxford

handbook of substance use disorders, vol. 1. New York: Oxford; 2016. p. 351–74.

Miller, F. T., Abrams, T., Dulit, R., & Fyer, M. (1993). Substance abuse in borderline personality

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Saulsman LM, Page AC. The five-factor model and personality disorder empirical literature: a

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Trull, T. J., Sher, K. J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality

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Trull, T.J., Freeman, L.K., Vebares, T.J. et al. Borderline personality disorder and substance use

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https://doi.org/10.1186/s40479-018-0093-9