Double Trouble: Borderline Personality Disorder and Substance Abuse

My name is Becky, and I have a dual diagnosis.

*crickets chirp in background*

One possible symptom of borderline personality disorder (BPD) is substance abuse. When a person has a substance abuse disorder and a psychiatric disorder, they have a dual diagnosis. While help exists for people with mental illness and for people with substance abuse problems, getting help for a dual diagnosis is a lonely, uphill battle. Simply put, neither psychiatric facilities nor rehabilitation facilities have the desire nor ability to treat us.

$obriety i$ co$tly

I forget which sobriety attempt this was--there've been so many--but I was looking into rehab. I'm on Medicaid.

If you laughed in contempt and said "Good luck", you can skip this paragraph. Rehab is expensive--the low end being $10,000 for 30 days. It's hard to come up with that kind of cash even with a job, and a dual diagnosis patient probably doesn't have one. This is especially true when BPD is involved. No job means no income, and no income means "How do I pay for this?" The resulting financial stress can trigger BPD symptoms and/or a relapse, and the cycle starts all over again. The patient goes deeper and deeper into debt, becoming more and more stressed, becoming sicker and sicker.

Most rehab facilities are designed for people with money and insurance. Most rehab facilities are designed for sane people. Very few rehab facilities will take a low-income, uninsured or Medicaid patient.

Collateral damage of a turf battle

During one sobriety attempt, a partial hospitalization program nurse found a rehab facility that took Medicaid. I called the facility and explained my situation. As soon as I mentioned I was on psychiatric medication, the receptionist said they couldn't take me without a note from my psychiatrist vouching that I was safe.

You guessed it--he refused to write the note. He didn't give me a reason. I don't think he realized the severity of the problem; he told me my fatty liver was probably caused by poor diet.

I went to the hospital's Crisis Intervention Unit and explained the problem. They told me there was a medication that could prevent the withdrawal symptoms, but I'd have to come every day to take the pill and check in with the nurse. I still felt horrible physically and psychologically, but I figured something was better than nothing. Even with the medication, I was still high-strung, mildly manic and hallucinating.

The rehab clinic didn't want to deal with the psychiatric issues. The psychiatrist was in denial about the substance abuse issues. I suffered a chaotic and painful detox as a result.

When our needs go ignored

I finally gave up trying to sober up on the outside. I was committed to the state hospital system, and admitted to Richmond State Hospital in Richmond, Indiana.

Although I was on a dual diagnosis unit, my needs weren't understood. Emphasis was placed on treating substance abuse--to the point where my psychiatric issues were virtually ignored. The experience was a nightmare. I was denied medical treatment for an asthma attack (the inhaler prescription hadn't been filled, and I might use it to get high). I rarely saw a therapist despite a strong recommendation for therapy. When I became suicidal after the suicide of someone I knew, the staff assumed, based on my BPD diagnosis, that I was trying to get attention and ignored me until I made the attempt. Patients often joked "This place will drive you to drinking."

The fear of being sent back was a powerful motivator to stay sober--until the facility closed, with the State's explanation that the new focus would be on community-based treatment. The problem is that said treatment doesn't exist, which is why many of us were there in the first place. The stigma of a dual diagnosis is so bad that there's a Dual Recovery Anonymous 12 Step group, where people can discuss their symptoms without being accused of addiction (after all, we are taking pills to feel better.)

Ultimately, when it comes to being clean and sober in spite of BPD, we're on our own.