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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 is being conducted to 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 be able to

understand how mental health plays a role in individuals who develop Substance Use Disorder.

When we are able to treat the underlying mental health issue we will be able to better treat the

substance use issue. If we just 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 are able to 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 10 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 sky rocket 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 as well

as 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, then those individuals with BPD only

(Link, 2005). The following questions will be used to help gather information to be utilized in

the study and help to 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, 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 which was published in 1994.

There are 10 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

from 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 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 then the individual is considered to have a mild substance use disorder. If

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

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 in order 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, others 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 as well 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, 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 to be able to verify the findings of the study. The interviews 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 are able to treat both mental health as well as 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 very important

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, often
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individuals with BPD often 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 whom 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 personal relationships, as well as functioning in society. BPD can be though 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’s

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

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

regulation as being a primary role of serious substance use and problems 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 affect (Cooper, 2016). Impulsivity which is

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

BPD, can often lead to negative consequences including but not limited to substance abuse as
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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 in the 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 the borderline individual.
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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

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

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