Personality Disorders

Antisocial and borderline personality disorder are common presentations to alcohol and drug services. Two systematic reviews have identified Dialectical Behaviour Therapy for Substance Abusers (sic DBT-S), Dual Focused Schema Therapy (DFST) and Dynamic Deconstructive Psychotherapy as effective in reducing symptoms of borderline personality disorder in people with substance use disorders.  Because of the training needs and the complexity of delivering treatment Lee et al (2015) recommend DBT-S over the alternatives.  

There is very little direct clinical trial evidence to inform choice of pharmacotherapy. One trial found that naltrexone and disulfiram had similar effects in people with a comorbid diagnosis of either anti-social personality disorder or borderline personality disorder compared to those with alcohol use disorder alone.  

Chapter Recommendation Grade of recommendation
21.45 Dialectical Behaviour Therapy (DBT-S) should be provided to people with comorbid Borderline Personality and Alcohol use Disorder B