Half or more of patients with borderline personality disorder (BPD) suffer from co-occurring alcohol use disorder and/or drug use disorder. The aim of the study was to investigate the development of substance use disorders (SUD) in patients with borderline personality disorder (BPD) in the long-term course.

175 patients with BPD and 396 patients with other personality disorders (OPD) were assessed with semistructured interviews at baseline and at 6, 12, 24, 36, 48, 60, 72, and 84 months. They were compared on the frequency of new onsets of SUD. Kaplan-Meier analyses were used to to generate time to new onsets, and Cox regression analyses were used to examine relevant predictors for new onsets.

BPD patients did show a shorter time to new onsets of SUD than the OPD group. Thirteen percent of BPD patients developed a new alcohol use disorder, and 11% developed a new drug use disorder, as compared to rates of 6% and 4% respectively for OPD. The number of antisocial personality disorder (ASPD) criteria predicted new onsets of SUD in BPD.

Patients with BPD have a two to three times higher risk than patients with selected other personality disorders of developing a new SUD. The severity of antisocial psychopathology is related to new onsets of substance use disorder in BPD. These findings support the concept of a spectrum relationship between ASPD, BPD and SUD.