Alcohol use disorders (AUDs) affect more than half of individuals diagnosed with borderline personality disorder (BPD), according to a large meta-analysis highlighted in the European Medical Journal. The findings show that dual diagnosis, integrated screening and treatment strategies are required to improve long-term psychiatric outcomes.
Borderline personality disorder is a complex mental health condition characterised by emotional instability, impulsive behaviour, unstable interpersonal relationships, and disturbances in self-image. Individuals with BPD often experience intense mood fluctuations and may engage in high-risk behaviours.
Previous research has shown a strong association between BPD and substance misuse, particularly alcohol.
Alcohol misuse in BPD is clinically significant. It can:
Increase impulsivity and emotional dysregulation
Heighten the risk of self-harm and suicidal behaviour
Interfere with psychotherapy and medication adherence
Worsen long-term functional outcomes
Accurate prevalence data are therefore critical for improving psychiatric care.
The meta-analysis and meta-regression reviewed 15 studies comprising 15,603 individuals aged 18 years and older diagnosed with BPD.
The primary objective was to estimate pooled prevalence rates of alcohol use disorders among individuals with BPD and to examine variability across studies.
The pooled analysis revealed:
55.28% prevalence of alcohol use disorders (AUDs) among individuals with BPD
44.59% prevalence of alcohol dependence
18.84% prevalence of alcohol abuse
When compared with general population estimates, approximately 8.6% among men and 1.7% among women, the burden among individuals with BPD is markedly elevated.
These results confirm that alcohol-related disorders represent a highly prevalent and clinically significant comorbidity in BPD populations.
The findings reinforce the importance of routine alcohol screening in patients diagnosed with BPD. Dual diagnosis, where a psychiatric disorder coexists with a substance use disorder requires coordinated management.
Integrated treatment strategies may include:
Structured psychological therapies addressing emotional regulation
Evidence-based addiction treatment programs
Close monitoring for relapse and self-harm risk
Coordinated psychiatric and addiction services
Early identification of harmful drinking patterns may reduce complications, improve treatment adherence, and enhance long-term prognosis.
Although the meta-analysis focused on prevalence rather than causation, previous research suggests several mechanisms that may explain the association:
Impulsivity and difficulty regulating emotions may increase vulnerability to substance use
Alcohol may be used as a maladaptive coping strategy
Neurobiological overlaps in reward processing and stress regulation may contribute
Understanding these pathways is important for designing targeted interventions.
The meta-analysis confirms that alcohol use disorders affect more than half of adults with borderline personality disorder, representing a significant clinical challenge. Routine screening and integrated psychiatric and addiction treatment approaches are essential to improve outcomes in this high-risk population.
Reference
Silva SG et al. “Strong Link Between Borderline Personality Disorder and Alcohol Use.” EMJ Reviews, February 23, 2026. https://www.emjreviews.com/general-healthcare/news/strong-link-between-borderline-personality-disorder-and-alcohol-use/.