Borderline Personality Disorder,  Substance Abuse,  Treatment

BPD and anti-anxiety (benzo) abuse – a call for help

A few months ago a member of my Google Support List for Non-BP’s issued me a challenge. I have noticed that many people with BPD abuse prescription drugs, particularly anti-anxiety medication. Mainly the abuse seems to be of benzodiazepines (aka benzos) which include Xanax (generic alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) and others (although those seem to be the most popular). I listened to a podcast by a psychiatrist who treats borderline patients. He says almost all of them eventually ask for Xanax.

Xanax has to be the absolute worst drug to treat BPD. Why?See the results of these (rather old) studies:

Alprazolam (benzodiazepine)

Gardner, D.L. & Cowdry, R.W.
Am. J. Psychiatry. 1985 – Alprazolam-induced dyscontrol in borderline personality disorder.
The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD
The authors suggest that caution be used in prescribing alprazolam to patients with similar histories.

Alprazolam (benzodiazepine) / carbamazepine and trifluoperazine and tranylcypromine.

Cowdry RW, Gardner DL. – Intramural Research Program, National Institute of Mental Health, Bethesda
Arch Gen Psychiatry. 1988 – Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol

My wife has gotten much better since I started on this quest of learning about BPD and what, as a loved one, I can do about it (and what I can’t). Yet, she still over-medicates on benzos. So, my list member basically issued me a challenge to see if there is anything I can figure out to do to reduce the pill taking. One member of the list locks up his wife’s pills and doles them out when she needs them. I hesitate to follow his example because I don’t want to be in the position of being my wife’s keeper. Plus, in the past when I have held her pills for her (usually at her request), I have been raged at for “hiding” or “stealing” them (neither of which I do).

Here is my question/challenge: Have any of you been able to come up with an effective way to reduce over-medicating on benzos? That question goes out to the people with BPD (if you have found a way yourself) and to the family members (if you have found a workable solution). This area is one where I have made little head-way and would like some help.



  • Wandering Coyote

    Ah, Benzos. In addition to what you cited above, they are incredibly addicting and it always peeves me when I see people with a history of addiction or addiction in their family are given benzos to aid with BPD issues. (I am not suggesting your wife is an addict; I was referring to people in my own life with BPD and addiction issues whose GPs prescribe them benzos.)

    I have a small amount of ativan on hand for emergencies, and I honestly take it maybe three or four times A YEAR, just because the last thing I need is an addiction in addition to everything else.

    As for your wife and what to do…My advice would be to not keep benzos around AT ALL…Get rid of them, and if she really, really needs a mediation to help her settle down, perhaps a small dose (12.5 – 25mg) seroquel would be worth asking the doctor for.

    Apart from that – DBT. Really. If it’s not an option for you, get the course materials from the Marsha Linehan books.

  • Bon Dobbs

    Well, I think keeping them out of the house is easier said than done. Clearly to me they are a problem. Almost ALL of my wife’s impulsive behavior in the past few years has been fueled by benzos. As for addiction, she certainly has a psychological addiction. She took seroquel before and tells me it “doesn’t work” (same with buspar and the others).

    DBT IS an option for us – the main issues is paying for it and getting her to go. I recently bought the “DBT Workbook” and showed it to my wife, telling her it would help with our daughter, but I think she threw it away.

  • lildelil

    ” I listened to a podcast by a psychiatrist who treats borderline patients. ”

    This is perhaps a bit off topic and it is not to discount or ignore all the other information in your posts (which I am still reading and thinking through), but this particular mention just leapt out at me. Do you recall the origin of the podcast or any details ? I think it must have been very interesting and if you do remember the source I think others might be interested also.

    (I am the battle weary but still struggling on mother of a daughter with BPD. I agree absolutely with your statements about theoretical expertise compared with “been there , done that, at the coal face” experience and knowledge. Quite frankly if one more professional tells me that he “understands how difficult it is” I think I might just start screaming. NOBODY who hasn’t lived this scenario can understand.)

  • jjane123

    Not sure about Benzos, but I can second the helpfulness of DBT in helping control my own love of sleeping pills and self-harm. I’ve just begun (about 4 weeks ago) an intensive BPD program, and I already can see the positive effects on my behavior and *maybe* even on my mood.

    But I couldn’t have been forced to go. This was my own decision after years of suffering. If your wife’s not ready to go, some tough love might be in order. How much are you doing for her? Does she ever have to live with the consequences of her actions or do you cushion her fall every time? As a BPD myself, I’m going to talk straight: We’re childlike (and childish), but we need to be treated like adults. My SO has been very supportive and that’s included treating me like someone who’s responsible and competent even when I was being highly irresponsible and acting incompetent. I think a lesson can be learned from the treatment of those with physical disabilities–it’s better to watch them struggle and eventually gain mastery than to help them in the short-term and keep them dependent on others in the long-term.

    Perhaps you’re already doing all this, but I thought I’d mention it.

  • Bon Dobbs

    Yes, well, the podcast was a couple of years ago. I’ll try and dig it up and post a link. As for “been there, done that” I have and I have met hundreds of people – both in life and on-line – who have as well. I DO know what you mean about the professionals. My daughter goes to a practice that specializes in BPD. The leader of the practice is a world-renowned expert in teens with BPD and suicide. Yet even HE is hard to believe when he says that. I knew a young woman (she’s 19) whose older sister (22) has BPD and is a heroin addict. Anyway, she (the young one) interned at this practice and found the clinicians talking about how bad the parents were. She says, “Well, maybe they’re completely exhausted dealing with the borderline.” That floored them (because she was SO spot-on). She knows what it’s like to have a family member with the disorder and having to deal with this person more than 1-2 hours a week – she has been dealing with her sister all her life. The families spend the most of the time with the BPs. They need support, skills and help. It;s funny that DBT therapists have a “support the therapists” program, but do not always have a support the families program.

  • Bon Dobbs

    Well, my daughter goes to a pre-DBT program – she’s only a pre-teen so BPD doesn’t really apply, but she definitely has emotional regulation issues (and some other BPish stuff). She got to the point where she was unhappy with feeling that way so she started. She’s built mastery over a lot of stuff, including her anger, which was the first problem the therapist dealt with. My daughter is now “cutting back” on therapy because she’s doing so well. As for my wife, she argues we can’t afford DBT – but the real reasons seem to be 2 two: 1) she doesn’t like to think of herself as a BP and 2) she doesn’t want to fail at the “last resort” therapy for her. Today she injured herself (not self-injury, an accident) when over-medicating, so perhaps that will serve to wake her up to her issues a bit more. She’s actually doing much better than 3 years ago when I started this quest. A big part of it IMO has been my less judgmental attitude and more understanding of the issues.

  • jjane123

    Yes, I can understand that your wife might be afraid of failing at “last resort” therapy. But it isn’t really her last resort, right? I was very afraid of that myself, I kept putting if off, thinking “I’ll do that if I *have* to, if I’m in *that* place.” But really, even if I “fail” at this, there are even more intensive options (e.g. partial hospitalizations), and there’s no real time limit on my program. Most people stay in my particular program for around a year, but you can stay longer than that if it’s still useful to you.

    Here’s what my program looks like:

    Group once a week (DBT skills and homework)
    Individual Therapy 2X a week
    Psychiatry as needed

    Here are some of the surprising things to me about the program: they are very strict about attendance (you can be kicked out for not attending regularly). If you just don’t show up for any appointment and don’t answer your phone, they’ll send EMS to your house (!). They require you to sign a contract saying that you’ll stay in the program for at least 12 months. They require you to sign a contract saying you’ll immediately reduce suicidal behavior/self-harm (!). They require you to report any and all maladaptive behavior (cutting, screaming) to your therapist asap. And lots more. The net result is that a *lot* of responsibility is placed on the patient immediately.

    Even before you have any DBT skills, you’re thinking about how to minimize these behaviors, you know you have to call your therapist if you’re in a situation where you might act out, and so on. It’s made me feel more in charge of my behavior.

    Also, my therapist requires me to actively describe all of my feelings and thoughts. And she challenges me to come up with my own solutions to problems. “What could you have done instead of x?”, etc. Unlike w/ the talk therapy I’ve done in the past, everything’s very concrete. e.g., my therapist and I have recently agreed that it might help me to sign up for a yoga class and to practice visual -stimulus meditation (since meditating on my feelings is too painful for me at this point). We’ve also agreed I need to always be sure to wear my watch since I’m frequently late to things (because I disassociate and lose track of time). My other therapists liked to stay abstract, but right now, I need advice on these little things and the fact that I’m co-authoring all of these plans helps me to feel I own them.

    Overall, I’m really enthusiastic about this kind of treatment and only wish I’d started years ago.

  • Bon Dobbs

    I do know a lot about DBT. I attended a DBT family skills training class and have been working with DBT advocates in NY for more than 2 years. I think DBT is great. Everything you’ve said here about your DBT therapy is exactly in-line with what I have learned. I use those skills – like the behavior chain worksheet and asking “what else could you have done…” with my daughter as well as validation and other stuff (hey, it’s all in my book). But I’m not promoting DBT-only skills there. I have found some other skills that are equally as effective for family members. It’s wonderful to hear you are excited and “into” DBT – I think that is when it would be best and most effective. I have watched the Marsha Linehan videos in which she re-creates her DBT sessions. Wow! She’s pretty concrete and to the point with the BPs – especially with self-injury and suicidal ideation. I wish the best for you and hope DBT will help you build a more peaceful life.

  • DP / Momma

    I wish I could give you the answer. I am also a “non,” mother to a daughter with BPD. Our relationship is fractured, partly because of her medication abuse and her stealing/lying/etc. She was, at one point, prescribed 1mg of extended release Xanax 3 times a day. She would go to other doctors and get fast-acting Xanax, too. Clearly she wasn’t straight with her doctors about her diagnosis from past medical history. She also had a bad habit of drinking while taking Xanax. I don’t know what’s going to happen to her, and I’m scared. I keep hoping she’ll encounter the right doctor or therapist, but she won’t let me into her care at all.

    I find your site very informative, and clearly you care deeply for your wife. I know how hard it is some days, though.

    Peace – D

  • Bon Dobbs


    Thanks for your comment. My wife has done the same – either crushing extended pills or getting multiple prescriptions. DBT is an excellent therapy and I highly recommend it. Unfortunately, it is difficult to get someone to go – that is, it is impossible. Is your daughter an adult? Is she a teen?

    I’m glad you find the site informative – I have done the best I can to educate myself about BPD and try to dispell some myths about it.

    Your daughter is in a lot of emotional pain. She is doing what she knows to squelch it. However, there ARE more effective ways of doing so. I hope she will find her way. At some point it might be that her life becomes unlivable/unmanageable. When that happens BPs will either get help or try to commit suicide. I;m not trying to upset you, just pointing out the realities. She needs help, but she will have to choose to get it.

  • DP / Momma

    Bon –

    My daughter is 24, and she has wanted to be rid of us (and yet not) for 8 years. It was at age 16 that she declared herself an adult and didn’t want to be under our “control” anymore. The last time she had a halfway decent outlook was when she was a minor and was taking her anti-psychotics.

    I also read your post on lying and shared it with my husband, son, and best friend. They are all acutely aware of (and often victims of) Daughter’s lying. It was comforting to read that maybe this is the only way Daughter knows how to get through a “normal” relationship. My own therapist has been extremely helpful in getting me through the rough times and accepting that I can’t change my daughter. I have also returned to church. That also gives me comfort.

    I hope that someday Daughter does get into DBT, but she even denies her diagnosis, as I said. She has tried suicide several times, the last time just before Christmas 2007. I’ve tried to accept that that may be how she dies. It hurts, but I have no control.

    Peace – D

  • Bon Dobbs

    So she’s an “adult” – I put it in quotes because emotionally she probably does not behave as an adult (or feel like one). Control seems to be an issue in BPD – taking meds can certainly help.

    I’m glad you are comforted by church and have a support system yourself. The lies are definitely infuriating, yet in BPD the motivations can be understood IMO. Denying her diagnosis is not surprising either. BPD comes with a huge stigma. Many people believe it’s just bad behavior, but it is a true emotional/mental illness and takes time and effort to overcome. Acceptance for you is an excellent tool. It does hurt to think of her dying at her own hand (or never getting help) so you have in effect validated your own pain (by acknowledging that it hurts) and, at the same time, accepted your limitations. I think that is the most effective approach for peace within yourself (no matter how badly it hurts).

    Peace to you!

  • andrew

    i’ve lived with a bpd wife and i’ll tell you, they aint fun!..loving her was the most emotionally absorbing experience i’ve ever gone through.

    i gat rid of her for my own safety!…sent her to her family!. borderine peeople are a real drag!..

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