Substance abuse and borderline personality

Once upon a time, people with a disproportionate sense of self-importance, with grandiose fantasies of power and domination over others, the so called “narcissists”, were the majority in alcohol and drug rehabilitation centers .

These individuals want to be admired, they believe that everything is due to them, they think they are “special” and superior to others as well as to the rules of civil life. Often they believe themselves to be omnipotent, unwilling or unable to see the feelings of others, except their own.

Today, more and more, we see people with a character structure similar to that of the narcissist, but more disrupted, disorganized, chaotic: the borderline. The narcissist and the borderline both suffer from the “King-Baby” syndrome*, but in different ways.

(* I will use the masculine only for convenience, but in the same way we can speak of the Queen-baby.)

The  BPD  is one of the results of today’s disintegration of families and communities in western society. 

More than half of the children now grow up in broken families and often one of the parents is absent (usually the father). They are shaped in an atmosphere of precariousness, instability, unpredictability and insecurity at all levels. Parents in difficulty, often become absent, distracted, indulgent, absorbed by themselves and their own instability,  do not give security and emotional certainty, do not make the effort to establish boundaries for their children, do not enforce the limits and give in. To pacify the children, parents give them what they want, not what they need . When they don’t get what they want, they have a tantrum, go on a rampage. Often children have to do the absent parent’s job themselves, sometimes even going so far as to “protect” them.

In essence, the roles are reversed and these children do not grow up as children: they are used narcissistically for the needs of their parents and their boundaries are invaded. They take on responsibilities and concerns as adults, not appropriate for their young age, they have to take care of their siblings, cook and so on. At the same time they have excessive freedom, they receive material goods, but they are not seen for who they are and what they need. 

In these families there are no rules or supervision, the children are left to fend for themselves, sometimes there is no one to take care of them. Outside the home they are the favourite preys for bullies.

Their home environment is filled with conflicts, threats, violence, explosions and even traumatic experiences. With this great instability in the home, they don’t feel safe and secure. They don’t have emotionally available parents to teach them to value their feelings, sensitivity, empathy, human connection, respect for others, and how to regulate their emotions. They develop in an environment where there’s no time for peaceful, calm, joyful and creative activities, encouragement to cultivate what one wants, self-respect and self-esteem. They are taught that in life it’s not worth making an effort for what you want, or delaying instant gratification for greater benefits in the future.

The children thus become adolescents with the illusion that they are the ones who govern the house. In life outside the family, they do not accept  “no”, rules, boundaries, limitations, guidelines and advice. They don’t want to be taught. They think they rule over everyone, that they can dominate and even tyrannize others. If they don’t immediately get what their impulses want, they become destructive, threatening, explosive and abusive.

Often, they also begin to use  stimulants (cocaine, crack, amphetamines, mdma, synthetic drugs …) or disinhibitors (alcohol, ghb, ketamine …). They feel omnipotent, they throw themselves into adrenaline-fueled and risky situations, which will later prove to be dangerous and harbingers of heavy consequences. With the use of substances the first failures begin, the abandonment of school, entry into criminal activities and gangs, problems with the police and justice; and so begins the descent, the devastation of their young lives.

These individuals are very fragile and vulnerable inside, sensitive to any kind of criticism; in human relationships they are afraid of being abandoned, they feel inadequate, full of shame and worthless; they do not feel worthy and deserving of love. They themselves are afraid of their own anger and uncontrolled outbursts, but they don’t know how to contain, protect and manage themselves. They believe the street has taught them that the only self-respect is to use violence, and nothing else. In the presence of even minimal conflicts, problems or difficulties, they explode, shatter, act impulsively and without rationale, with the result of often sinking into depression.

The frail king has fallen, he has lost power and control.

Acceptance of reality and defeat is the only salvation
Many of the baby-kings just described have now become chronologically adults. The use of substances has grown over time and doing “their way” has led them to multiple failures and setbacks.

When they arrive at rehab centers, the adult ‘kings’ are more and more in the ‘dust’. They have fallen miserably several times. They have failed in emotional relationships and often also at work. They are still full of anger and impulsive, but in the meantime, anxiety, depression, feelings of worthlessness, as well as the threat of self-destructive or suicidal actions have grown in them . Despite bankruptcies, insecurity, fragility, mood swings, lack of self-esteem and internal authority, they are  still  ambiguous about respect and acceptance of borders, rules, external authority, help. 

Somewhere, they still have the illusion that they have power and control.

In the time of intensive therapeutic treatment offered at a rehab centre, the borderline personality has the opportunity to experience what it means to accept “no”, not get what you want immediately, but to give in, surrender, follow other people, respect boundaries and rules. In essence, letting go of that false and illusory feeling of power, of still being in control, in command.

In fact, for a long time already addiction has taken more and more control of their lives. The substance controls them.

If they can tolerate this new reality, let go of the struggle for power and accept defeat, a new world will open up for them. By giving up control and accepting to be helped, they find a safe place where they no longer have to dominate and therefore find the opportunity to relax, feel their frailties and needs, learn to defend themselves and not be invaded, to respect themselves and to have borders.

Clear rules and structures, taking on one’s own responsibilities and respecting those of others, bring calm and security. Borders are not “prisons”, on the contrary: like the banks of the river, they are guarantees, they allow the water to flow safely without overflowing and the energy instead of producing flooding, can be used creatively and vitally.

From impulse to feeling
The main characteristic of the addict-borderline  is impulsivity . They themselves are afraid of their own impulses, of this uncontrollable and intolerable rage that floods everything and everyone. As soon as they have an impulse they take action, wanting to get right immediate reward and gratification. Not knowing the “no”, everything becomes anxiety, constant restlessness, reaction and continuous movement. There is no awareness of what it means to wait, stand still and breathe.

To “feel”, on the other hand, one must “not act”: one must stop, wait, listen to oneself, begin to reflect on what one really wants. The impulse does not know the emotional resonance of what is done. Feeling, on the other hand, allows us to perceive our own internal world and that of others. It is only then that one feels: pain, shame, anger, fear, sadness, needs, affection. The true feeling needs time, it is necessary to stop to recognize it, not to remain on the surface, to ponder the choices and then take the right action.

Each realization takes time. Impatience is one of the borderline’s greatest character flaws. ” Give time to time ” says a slogan of the 12 Steps and the ancient proverb says that the hasty cat makes blind kittens . We see it with common sense in everyday reality: the greatest successes and changes arise from adversity, from the acceptance of defeats, from the “no” received, from starting over and growing over time. Not getting what you want right away is often a blessing, as it forces people to re-evaluate things, opens the door to new opportunities and information, which we would otherwise have overlooked.

Body psychotherapies have proved particularly effective in calming anxiety, fears, the nervous system: for this reason the humanistic approaches, bioenergetics, mindfulness, yoga,meditation and the like are today the modalities widely used in rehab centres around the world.


Ermanno Bergami September 2021