Peter R. Neal, LPC, MED, PhD

Those suffering with a substance abuse addiction are often unable to cease their behavior without some form of medical intervention. Studies have found that repeat use of certain drugs can figuratively rewire the brain, resulting in alterations to neural pathways associated with dopamine. This means that repeat drug users may become reliant on consuming the substance in order to function. For example, those with alcohol addiction ("alcoholism") become physically dependent on alcohol and may experience extreme withdrawal symptoms when avoiding alcohol entirely; in rare cases, medically unsupervised withdrawal can lead to death.

Behavioral addictions are similar to substance abuse addictions; however, people with behavioral addictions are addicted to a behavior or emotion associated with certain behaviors, as opposed to drugs. In addition to gambling, common behavioral addictions include food, video games, social media, shopping, and pornography addictions. When performing the activity, people experience euphoria (a rush of dopamine) that slowly lessens over time, meaning they build a tolerance and dependency on a behavior. For example, people who are addicted to shopping may need to purchase more items or spend more money to feel the same rush that once fueled their addiction.

Addictions can be assessed through a variety of means such as diagnostic screening, abuse assessment, or psychiatric evaluation. Treatment can help patients recover from their addictions and manage mental and physical health conditions related to their addiction. People with addictions may be treated in rehabilitative treatment facilities, hospitals, and other clinical settings.

Addiction treatment for substance abuse may include:

• Detoxification (withdrawal from an addictive substance)
• Pharmacotherapy (prescription medications), such as buprenorphine-naloxone (Suboxone), disulfiram, and naltrexone to ease withdrawal symptoms
• Overdose treatment, such as the administration of naloxone (also known as Narcan)

Addiction treatments for both substance abuse and behavioral addictions may include:

• Addiction therapy and psychiatric care, such as cognitive behavioral therapy (CBT)
• Prescription medicine for co-occurring psychiatric disorders
• Twelve-step programs and support groups, such as Alcoholics Anonymous (AA) or Food Addicts Anonymous (FA)

Addiction treatment has expanded to include care for patient substance abuse in non-clinical settings. A number of community programs now provide at-risk substance users a safe place or means to use drugs and mobile doctor's services for drug-associated illnesses and injuries. Behavioral addictions are also gaining increased attention as researchers and mental health professionals seek to better understand and treat them. For example, some researchers are assessing the connections between video game addiction and childhood risk factors. More and more, mental health experts are recognizing the importance of meeting people with addictions where they are at, using more advanced treatments. Addiction treatment is intended to care for people with addictions with compassion and respect.

Borderline personality disorder is diagnosed by a psychologist, psychiatrist, clinical social worker, or other mental health professional. The disorder is a type of "Cluster B" personality disorder, which are chronic conditions characterized by unstable and dysfunctional behaviors that affect one's relationships with others. People with BPD often have co-existing mental conditions, such as depression, anxiety, PTSD, or substance abuse.

Borderline personality disorder is known to develop and become present during adolescence, however, mental health providers rarely diagnose anyone under the age of 18 with BPD. Mental health providers analyze behaviors, family history, and discuss symptoms with their patients, which may lead to a diagnosis using the DSM-5 criteria for BPD.

Borderline personality disorder is treated with psychotherapy and oral medications. Forms of therapy like dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) can help people with BPD identify self-destructive attitudes and harmful behaviors, which they may then be able to manage or change. Group therapy is another treatment option which may improve people with BPD's ability to share their emotions and to promote positivity. Psychiatrists may prescribe patients antidepressants and/or anxiety medications such as Prozac (fluoxetine), Wellbutrin (bupropion), and Zoloft (sertraline). Some patients may receive antipsychotic drugs which can help stabilize mood and reduce impulsivity.

With consistent treatment, people with BPD are able to recognize and prevent destructive behaviors and mood swings, typically by changing their patterns of thought. Many people with borderline personality disorder are able to live successful and healthy lives.