You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Borderline personality disorder (BPD) is a serious illness that commonly co-occurs with substance misuse, especially alcohol use disorders (AUD). Approximately 50% of psychiatric inpatients with BPD also meet diagnostic criteria for AUD (Zanarini et al. 2004). Among patients being treated for AUD, the prevalence of BPD ranges from 16 to 22% (Morgenstern et al. 1997).
Co-occurring BPD worsens the outcome of alcohol recovery, including unplanned discharges and multiple measures of problem drinking (Morgenstern et al. 1997). Likewise, co-occurring AUD is associated with more severe BPD psychopathology (van den Bosch, Verhuel, and van den Brink 2001), as well as a poor response to psychotherapy (Ryle and Golynkina 1998; Zanarini et al. 2004). Various psychotherapy modalities have been developed for BPD, but these have largely excluded participants with co-occurring AUD from their trials (Linehan et al. 1991; Bateman and Fonagy 1999; Clarkin et al. 2001). Only two small, randomized controlled trials of psychotherapy have been conducted with participants having co-occurring BPD and substance use disorders, each employing fewer than thirty participants and demonstrating only modest efficacy with high dropout rates (Linehan et al. 1999, 2002).
The present study evaluates the efficacy of a form of psycho-dynamic therapy developed specifically for this co-occurring subgroup. Dynamic deconstructive therapy (DDT) involves individual sessions on a weekly basis and is manual-based (Gregory 2003). DDT has goals similar to those of other psychodynamic treatment models (Bateman and Fonagy 2004; Clarkin et al. 2001) in that the therapist facilitates exploration and reflective functioning, as well as integration