Substance use disorders among personality disordered patients admitted for day hospital treatment. Implications for service developments

Karterud, Sigmund; Arefjord, Nina; Andresen, Nina Elin; Pedersen, Geir

doi:10.1080/08039480802298705

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…BPD has been found as a significant risk factor for the persistence of SUD (Fenton et al, 2012 ), but remission of SUD in BPD in a 10-year study was also common (Zanarini et al, 2011). Treatment of patients with BPD/SUD has been described as difficult due to high dropout rates and to relational problems that make the process of establishing a therapeutic alliance challenging (Karterud, Arefjord, Andresen, & Pedersen, 2009).…”

Section: /30mentioning

confidence: 99%

Mentalization-based treatment for female patients with comorbid personality disorder and substance use disorder: A pilot study

et al. 2017

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Mentalization-based treatment for female patients with comorbid personality disorder and substance use 28/30 disorder: A pilot study Objectives: In this study, we investigated the feasibility of mentalization-based treatment (MBT) for patients with comorbid substance use disorder (SUD) and borderline personality disorder (BPD). No published study has ever specifically looked at MBT for these patients. Such individuals are known to have a very poor prognosis and harbor much pain and misery. Moreover, few randomized controlled trials exist on psychotherapy efficiency for patients with comorbid substance use disorder and borderline personality disorder. There is an urgent need for more knowledge on treatment for this patient group. Design: A pilot project within a naturalistic clinical setting with longitudinal data collection during treatment and at follow-up. Eighteen female patients attended a pilot project and participated in up to 36 months of treatment, according to the manuals. Patients were measured on primary (pre/post) and secondary (longitudinal) outcome measures before treatment, every six months during treatment, at the end of treatment, and at follow-up approximately two years after treatment. Methods: Statistical analyses of repeated outcome measures (GSI, CIP, GAF, WSAS, and RSES) and of pre/post measures (Axis I and II diagnosis) were performed with linear mixed models, and Cohens d was calculated. Results: Significant improvements on primary and secondary outcome measures were demonstrated, with effect sizes ranging from moderate to large. With respect to primary outcome, these SUD/PD patients were almost fully recovered from their SUD at follow-up (a predicted score of 0.2 Axis I SUD diagnosis at follow-up in comparison with a score of 1.8 at baseline). Conclusion: MBT as performed in this pilot project indicates promising results for patients with (mostly borderline) PDs and comorbid SUDs. Performing RCT studies is warranted.

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Section: /30mentioning

confidence: 99%

Mentalization-based treatment for female patients with comorbid personality disorder and substance use disorder: A pilot study

et al. 2017

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“…SUD patients with co-occurring BPD are described as more resistant to entering into treatment, less compliant with treatment, and demonstrating high behavioral disinhibition associated with a subsequent return to heavy drug or alcohol use (Bradizza et al, 2006; Van Horn and Frank, 1998). Karterud et al (2009) found that patients being treated for personality disorders (including BPD) who were comorbid for an SUD displayed more aggression during treatment and dropped out more frequently. Both Shevlin et al (2007) and Thatcher et al (2005) have also demonstrated that AUDs (and mood and anxiety disorders) are strongly associated with a high BPD symptom class group (endorsement of more criteria).…”

Section: Introductionmentioning

confidence: 99%

Borderline Personality Symptoms in Short‐Term and Long‐Term Abstinent Alcohol Dependence

Fein

Nip

2012

Alcoholism Clin & Exp Res

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Background Comorbidity of Borderline Personality Disorder (BPD) and Substance and Alcohol Use Disorders (SUDs and AUDs is very high. The literature suggests a negative synergy between BPD and SUDs, which may impact an individual’s ability to achieve and maintain remission of either disorder in the face of the other. Methods We examined lifetime and current (past year) BPD symptom counts in three gender- and age-comparable groups: short-term abstinent alcoholics (STA, 6–15 weeks abstinent), long-term abstinent alcoholics (LTA, more than 18 months abstinent), and non-substance-abusing controls (NSAC). Abstinent individuals were recruited primarily from mutual-help recovery networks and about half had comorbid drug dependence. BPD symptoms were obtained using the SCID-II, followed up with questions regarding currency, but did not require that BPD symptoms represent persistent or pervasive behavior such as would meet criteria for BPD diagnosis. Thus our study dealt only with BPD symptoms, not BPD diagnoses. Results Alcoholics had more lifetime and current symptoms for most all BPD criteria than NSAC. In general, STA and LTA did not differ in BPD symptoms, except for a group-by-gender effect for both lifetime and current anger-associated symptoms and for lifetime abandonment-avoidance symptoms. For these cases, there were much higher symptom counts for STA women vs. men, with comparable symptom counts for LTA women vs. men. Conclusions Our results suggest for the most part that BPD symptoms do not prevent the maintenance of recovery in AUD and SUD individuals who have established at least six weeks abstinence within the mutual-help recovery network – in fact the presence of BPD symptoms is the norm. However, we did find difficulty in establishing longer-term abstinence in women with anger-associated symptoms and abandonment avoidance symptoms.

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“…Studies that have evaluated the efficacy of psychotherapy in patients with SUD and comorbid PD 9 – 11 are sparse and often controversial. 12 , 13 In contrast, a variety of different psychotherapeutic interventions have been proven effective for PD in several prospective studies, 14 – 16 and similar outcomes are achieved regardless of whether the interventions are applied in outpatient settings, 17 – 21 day hospital programs, 22 – 27 or inpatient programs. 28 However, many of the studies that have investigated the efficacy of PD psychotherapy have excluded PD patients with concurrent SUD (PD-SUD).…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study

Lana¹,

Sánchez-Gil²,

Pérez‐Solà³

et al. 2016

NDT

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BackgroundConcurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce.MethodsThe study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months.ResultsThe baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables – the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits – improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups.ConclusionSpecialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.

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Substance use disorders among personality disordered patients admitted for day hospital treatment. Implications for service developments

Cited by 10 publications

References 27 publications

Mentalization-based treatment for female patients with comorbid personality disorder and substance use disorder: A pilot study

Mentalization-based treatment for female patients with comorbid personality disorder and substance use disorder: A pilot study

Borderline Personality Symptoms in Short‐Term and Long‐Term Abstinent Alcohol Dependence

Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study

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