The prevalence of alcohol use prior to episodes of non-suicidal self-injury in women with borderline personality disorder participating in a randomized clinical trial of dialectical behavior therapy

Objective: Alcohol use is an important, but understudied, risk factor for non-suicidal self-injury (NSSI), defined as deliberate physical harm to oneself without intent to die. Alcohol use may facilitate engagement in NSSI by increasing impulsivity and physical pain tolerance. Limited data also suggests that people engage in more medically severe NSSI under the influence of alcohol. Method: This study examined the use of alcohol prior to NSSI in a sample of 79 female patients with borderline personality disorder (BPD) who were enrolled in a randomized clinical trial of dialectical behavior therapy (DBT). We used multi-level modeling (MLM) to examine pre-registered hypotheses that alcohol use prior to NSSI would be related to the self-reported impulsivity of NSSI, physical pain experienced during NSSI, and the medical severity of injuries from NSSI. Results: Participants endorsed alcohol use prior to 21.96% (47/221) of NSSI episodes and roughly one third of participants (n=27) reported at least one episode of NSSI preceded by alcohol use. For NSSI episodes preceded by alcohol use, more than half (52.38%) of participants reported using alcohol up to the moment of initiating NSSI. Alcohol use was significantly associated with higher impulsivity of NSSI episodes (b=1.16, p=.041), but not physical pain from NSSI or medical severity of NSSI. Conclusions: Findings need to be replicated but indicate that alcohol use occurs frequently prior to NSSI and could be a target for reducing impulsive episodes of NSSI.