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Borderline personality disorder (BPD), a complex psychiatric disorder characterised by pervasive instability in emotional regulation, self\u2010image, interpersonal relationships and impulse control, is associated with substance use disorders and sexual risk behaviours. However, no study has examined the relationship between BPD and drinking alcohol before sex in the USA. This study examined the association between BPD and regularly drinking before sex in a nationally representative adult sample.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>Participants were 17\u2009491 sexually active drinkers from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models estimated effects of BPD diagnosis, specific borderline diagnostic criteria and BPD criterion count on the likelihood of regularly (mostly or always) drinking alcohol before sex, adjusted for controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Borderline personality disorder diagnosis doubled the odds of regularly drinking before sex [adjusted odds ratio (AOR)\u2009=\u20092.26; confidence interval (CI)\u2009=\u20091.63, 3.14]. Of nine diagnostic criteria, impulsivity in areas that are self\u2010damaging remained a significant predictor of regularly drinking before sex (AOR\u2009=\u20091.82; CI\u2009=\u20091.42, 2.35). The odds of regularly drinking before sex increased by 20% for each endorsed criterion (AOR\u2009=\u20091.20; CI\u2009=\u20091.14, 1.27)<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>This is the first study to examine the relationship between BPD and regularly drinking alcohol before sex in the USA. Substance misuse treatment should assess regularly drinking before sex, particularly among patients with BPD, and BPD treatment should assess risk at the intersection of impulsivity, sexual behaviour and substance use. 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