Occasional, social, not aimed at anything
Ordinary use. Worth knowing that it costs you more the next day than it costs other people, and otherwise not a concern.
Not a chapter in this book
Substance use
The book has no substance-use chapter — chapter 6 covers impulsivity and self-harm, and that is the nearest it comes. This page is general information, written without the moral framing that makes most writing on this useless to the people in it.
Why it works, which is the whole problem
Most writing about substance use starts from the premise that using is irrational. For someone with emotional dysregulation it is not irrational at all, and pretending otherwise guarantees the advice will be ignored.
Alcohol reduces emotional intensity quickly and reliably. So do several other things. When intensity is the central unbearable feature of your life, something that reduces it in twenty minutes without requiring a skill, a therapist or another person is not a mystery — it is the most effective tool available, and it works the first time, every time.
The problem is the accounting. The relief is immediate and the cost is deferred: worse sleep, higher next-day reactivity, disinhibition at exactly the wrong moments, and a slow erosion of the thing that made it bearable in the first place. Because benefit and cost land on different days, the connection is genuinely hard to see from inside.
There is a second cost that gets less attention. Every episode handled with a substance is an episode where a skill was not practised. Skills only become automatic through repetition at intensity, so a reliable chemical route out means the alternative never gets built — and two years later the substance is still the only thing that works, which is now true rather than merely believed.
None of this is an argument for shame, which is the least useful response available and the one most likely to produce more use. It is an argument for knowing what the arrangement actually costs, which is different from being told it is bad.
Nothing else available at eleven at night reduces an eight out of ten to a three in twenty minutes.
Where this actually is for you
Not a diagnostic instrument. A rough locator, so the next step is proportionate.
Sometimes to take the edge off
Common and worth watching. The question is whether it is one option among several or the reliable one. If it is the only thing that works, that is the direction of travel.
Planning around it, or hiding the amount
Hiding is the most informative single signal there is. If the quantity is being managed for an audience, the relationship with it has already changed.
Using to prevent a state rather than to enjoy anything
Functional use — drinking so a feeling does not arrive. This is the point at which the substance has taken over a job that will otherwise not be built.
Withdrawal symptoms, or unsafe when using
Do not stop alcohol or benzodiazepines abruptly without medical advice — withdrawal from both can be dangerous. This needs a doctor, and it needs one this week.
Questions people actually have
Answered without the lecture.
Is this in the book?
No. Chapter 6 covers impulsivity and self-harm and touches the territory. There is no substance-use chapter, and for this specifically a clinician or a specialist service is the right source.
Do I have to stop completely?
That depends on where you actually are, and it is a question for someone who knows your situation. Complete abstinence is necessary for some people and not for others, and framing it as the only option keeps a lot of people from asking anything at all.
Should I deal with this or the BPD first?
Both, ideally, and services are often organised as though that is impossible. Integrated treatment does better than sequential where it is available. If forced to choose, whichever is currently more dangerous.
Will they refuse to treat my BPD if I'm using?
Some services do have thresholds, which is a real and frustrating obstacle. Ask directly what theirs is. It is also worth knowing that many will work with you regardless, and that assuming refusal without checking is a common reason people do not ask.
What if it's the only thing that works?
That is an accurate description of the situation rather than a reason not to change it. It is also why substituting has to come before removing — a skill that works at intensity, practised until it is automatic, is what makes stopping possible rather than merely intended.
Where do I start?
A GP, an alcohol or drug service, or a peer-led group. Most take self-referrals, most are free, and none of them require you to have decided to stop before you turn up.
Educational disclaimer: this page supports book discovery and general learning about borderline personality disorder. It does not diagnose, replace individualised professional care, or provide emergency support. If you are in crisis, contact local emergency services or a crisis line — see the crisis support page.