Battling The November Blues: Alcoholism Awareness

November can be a difficult month for those struggling with alcohol use, as it is a time when many people start to increase their drinking due to the holiday season. For those with Borderline Personality Disorder (BPD), the risk of developing alcohol dependence is even higher. BPD is a serious mental illness characterised by pervasive instability and impulsivity in interpersonal relationships, self-image, and behaviour. It is often misunderstood and underdiagnosed. Those with BPD are more likely to turn to alcohol as a form of self-medication to cope with their intense emotions and stress. The comorbidity of BPD and alcohol use disorders is very high, with about half of those diagnosed with BPD meeting the criteria for substance misuse or alcohol misuse disorder. This makes diagnosis and treatment for both conditions challenging and complex. Recognising the signs of problematic drinking and understanding the link between BPD and alcohol use is crucial for seeking help and support.

Alcohol stimulates the endogenous opioid system (EOS)

The EOS is involved in three major functions: modulation of the response to painful stimuli and stressors, reward and reinforcement, and homeostatic adaptive functions, such as regulating body temperature and food and water intake. The three distinct families of endogenous opioid peptides are defined by their precursor molecules. For example, pro-opiomelanocortin (POMC) gives rise to β-endorphin, which is synthesized in the brain in the arcuate nucleus. β-Endorphin neurons of the arcuate nucleus project to various brain regions, including the ventral tegmental area (VTA) and nucleus accumbens.

Research has shown that dysregulation of the EOS may contribute to the initiation and maintenance of addiction. For example, levels of EOS mRNAs and dynorphins were found to be up-regulated in post-mortem specimens obtained from human alcoholics compared to controls. Additionally, dysregulated kappa-opioid receptors in the medial prefrontal cortex have been linked to working memory deficits in alcohol dependence.

Furthermore, acute or light alcohol consumption stimulates the release of opioid peptides, which trigger the reinforcing effects of ethanol. However, chronic heavy alcohol consumption induces a central opioid deficiency, which may be perceived as opioid withdrawal and may promote further alcohol consumption through negative reinforcement. Thus, the stimulation of the EOS by alcohol may play a critical role in the development and maintenance of alcohol addiction, particularly in individuals with BPD who may have an under-stimulated EOS.

Alcohol abuse can cause physical and mental strain

Alcohol abuse can cause significant physical and mental strain, and this strain can be even more pronounced for those struggling with borderline personality disorder (BPD). BPD is a mental disorder characterised by mood swings, behavioural changes, low confidence, and unstable relationships. People with BPD often have an intense fear of abandonment, paranoid tendencies, and impulsive behaviours.

Physical Strain

Physically, alcohol abuse can take a toll on the body's organs, particularly the brain, nervous system, heart, liver, and pancreas. Long-term alcohol misuse can lead to abnormal liver function, cardiovascular disease, and an increased risk of diabetes and heart attacks. It can also cause digestive issues, such as nausea, vomiting, diarrhoea, and indigestion. Additionally, heavy drinking can increase blood pressure and cholesterol levels, weaken the immune system, and contribute to bone fragility. Alcohol withdrawal can also have physical symptoms, including tremors, agitation, and, in some cases, seizures.

Mental Strain

Mentally, alcohol abuse can disrupt brain function, causing mood swings, angry outbursts, impaired memory, and concentration issues. It can also exacerbate underlying mental health conditions, such as depression, anxiety, and stress. Many people turn to alcohol as a coping mechanism to deal with difficult emotions or symptoms of mental illness. However, the relief provided by alcohol is only temporary, and as it wears off, individuals often experience worsened negative emotions due to the effects of alcohol withdrawal. This can create a cycle of dependence, where the individual relies on alcohol to manage their mental health, further exacerbating the problem.

The link between alcohol abuse and mental strain is particularly evident in individuals with BPD. People with BPD often have more cravings for alcohol and are prone to using it in excess due to their impulsive nature. Alcohol can temporarily dull their intense emotions and provide a sense of relaxation or escape. However, the unregulated use of alcohol can lead to addiction and further complicate their mental health struggles. The interplay between BPD and alcohol abuse creates a complex dynamic that requires careful diagnosis and treatment.

If you or someone you know is struggling with alcohol abuse and experiencing physical or mental strain, it is important to seek professional help. Resources such as local support groups, talking therapies, and medical advice from a GP or addiction specialist can provide guidance and support on the path to recovery.

Alcoholics tend to use alcohol as a coping mechanism

People with borderline personality disorder (BPD) are more likely to pick up and abuse alcohol. BPD is characterised by mood swings, changes in behaviour and confidence, and sabotaging relationships. People with BPD experience the feelings of others as their own, which causes a great deal of undue stress. Alcohol is the most common form of self-medication for people with BPD because it seems like a cure-all. It helps them relax, not overshare, and balance out their rage.

However, using alcohol as a coping mechanism has negative consequences. While it may provide temporary benefits, these are outweighed by the long-term negative effects on health and relationships, poor decision-making under the influence, and increased dependency. Alcohol abuse and dependence can arise from using alcohol as a coping mechanism. To address alcohol dependence, it is important to develop other effective coping mechanisms. This involves finding a sustainable solution to alcohol abuse by understanding what drives the problem and what exactly you are using alcohol to "cope" with.

The physical indicators of borderline alcoholism include abdominal pain, stress, anxiety, bad skin, trouble sleeping, irritability, and higher blood pressure. The most common long-term physical impacts are abnormal liver function, cardiovascular disease, diabetes, and mental health problems.

BPD and alcoholism share many common symptoms

Borderline Personality Disorder (BPD) and alcoholism are two highly complex, stigmatised, and often misunderstood mental illnesses. When a person has both BPD and alcoholism, diagnosis can be very difficult, mainly because both illnesses share many common symptoms. This is known as a dual diagnosis.

People with BPD have been shown to have more cravings for alcohol than people without BPD. This may be because alcohol stimulates the endogenous opioid system (EOS), which is often under-stimulated in those with BPD. Cocaine and opioids act similarly on EOS, and coincidentally, are also the other two most commonly misused drugs among borderlines. Alcohol is the most common form of self-medication for borderline people because it seems like a cure-all. Some think it helps ease intense emotions or pain, some see it as a social aid, and others find it a source of entertainment, especially when they’re alone.

Some of the specific traits of BPD are an intense fear of abandonment, paranoid and highly suspicious natures, “flipping” a conversation and deflecting, an inability to offer a sincere apology without projecting fault, and setting up situations where conversations become almost impossible. When alcohol is introduced into these situations, it is highly likely to be used in excess because the person with the disorder is so unable to regulate themselves they “overuse” and will often have no memory of the confrontations.

Alcoholics tend to use alcohol as a coping mechanism for stress, day-to-day problems, or other emotions. So do people with BPD. Borderlines are also likely to use alcohol regularly and in excessive amounts, often a warning sign of alcoholism. Alcohol, especially with chronic or long-term use, alters brain function, so it can cause mood swings and angry outbursts, often seen with BPD. Alcohol can also affect memory and concentration, both of which are common for borderlines in times of stress or dissociation. Borderlines are already impulsive and have a high risk of self-harming behaviour. Alcohol makes people lose their inhibitions and increases the risk of suicide.

BPD and alcoholism are dangerous if left untreated, and treatment for either one is not an easy task. Treatment, when both are involved, can quickly become even more complicated, but that is also when it becomes most necessary.

Long-term physical impacts of borderline alcoholism

While the term "borderline alcoholic" is not a clinical diagnosis, it may refer to someone who has an alcohol use disorder (AUD) or is experiencing symptoms of one. AUDs are associated with a range of long-term physical impacts, including:

• Liver disease, including cirrhosis (scarring of the liver), which can lead to jaundice (yellowing of the skin and eyes), ascites (fluid accumulation in the abdomen), and hepatic encephalopathy (confusion and cognitive impairment due to liver damage).
• Cardiomyopathy (damage to the heart muscle) and other cardiovascular problems, such as an increased risk of stroke, high blood pressure, and irregular heart rhythms.
• Pancreatitis (inflammation of the pancreas), which can cause abdominal pain, nausea, and vomiting.
• Neurological problems, including peripheral neuropathy (nerve damage in the extremities, resulting in numbness, tingling, and pain) and Wernicke-Korsakoff syndrome (a condition causing confusion, memory loss, and coordination problems).
• Increased risk of certain types of cancer, including liver, mouth, throat, and esophageal cancer.
• Weakened immune system, leading to a higher susceptibility to infections and other diseases.
• Malnutrition and vitamin deficiencies due to reduced food intake and impaired absorption of nutrients.

It is important to note that the long-term physical impacts of alcohol use disorders can vary depending on individual factors such as genetics, overall health, and the duration and severity of alcohol abuse. Additionally, borderline personality disorder (BPD) is often a comorbid factor in AUDs. Individuals with BPD may be more susceptible to developing an alcohol use disorder due to their heightened emotional sensitivity and poor impulse control. Conversely, chronic alcohol abuse can lead to symptoms similar to BPD, making it challenging to distinguish between the two disorders and delaying proper diagnosis and treatment.

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