The use of psychoactive substances and borderline personality disorder are psychiatric disorders that often occur in comorbidity. The causes of these disorders are multifactorial and not fully understood, with genetic, environmental, and psychological factors believed to play a significant role in their development. The main characteristic that connects these two disorders is impulsivity, which is defined as a behavioral trait characterized by a lack of impulse control, a tendency to act without considering the consequences, and impatience. Impulsivity, as one of the main links between borderline personality disorder and substance use, is an essential factor in better understanding these disorders and developing effective therapeutic methods for treating these patients. Due to the pronounced impulsivity, there is an increased risk of suicide, making it crucial to focus on identifying these patients and suicide prevention. Psychotherapeutic methods play a crucial role in the treatment of substance use in individuals with borderline personality disorder. Dialectical behavior therapy and dynamic deconstructive psychotherapy have shown promising results in treating these patients. DBT has been successful in reducing self-destructiveness and substance use in patients with BPD, while DDP is effective in promoting the expression of one's own emotions through the establishment of a stable relationship with the therapist, thereby alleviating symptoms of BPD. Pharmacotherapy is utilized solely as a supplementary treatment to psychotherapy, aiming to manage specific symptoms. Antidepressants, mood stabilizers, and antipsychotics are most commonly used to control impulsivity, affective dysregulation, and cognitive-perceptual symptoms. Further research and improvement of psychotherapeutic methods, as well as pharmacotherapy, will be crucial in achieving more effective treatment and improving the quality of life of patients with borderline personality disorder and substance use. A comprehensive approach that integrates various therapeutic modalities can provide the best results in the treatment of these patients.