The roles of emotion regulation difficulties and impulsivity in the associations between borderline personality disorder symptoms and frequency of nonprescription sedative use and prescription sedative/opioid misuse

Abstract

Despite evidence of a strong relationship between borderline personality disorder (BPD) and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = 0.04, 95% CI [0.003, 0.09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = 0.05, 95% CI [0.01, 0.11], and negative urgency, ab = 0.03, 95% CI [0.002, 0.07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.