QUESTION:

Dear Dr. Heller,

My son has been diagnosed with BPD and is also taking drugs, do we treat the disorder first or the drug problem? He is almost 18 and we feel we are running out of time!

DR. HELLER'S ANSWER:

I believe strongly that they both need to be treated. Most borderlines with substance abuse problems are treating their mental health problems with the wrong drugs. Others have profound substance abuse problems in addition to their mental health problems.

The right medications make all the difference in treating borderlines. Using as needed medications often makes the difference in controlling substance abuse. I believe a substance abuse program that teaches treating dysphoria (anxiety, rage, depression and despair) with appropriate medication has the best chances of long-term success with borderlines who also have a substance abuse problem.

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