Treatment for comorbid borderline personality disorder and alcohol use disorders: A review of the evidence and future recommendations.

Abstract

There is a high degree of comorbidity between borderline personality disorder (BPD) and alcohol use disorders (AUDs) including alcohol abuse (AA) and dependence (AD). There is some evidence that this pattern of comorbidity may be associated with poorer prognosis. Although there are many different psychotherapeutic and pharmacological treatments for BPD and AUDs when they occur alone, there are very few treatment options when they occur together. The objective of this paper was to review the existing treatment options—both psychotherapeutic and pharmacological—for patients with dual diagnoses of BPD and AUDs and to explore alternative treatment options that warrant further study. There have been a number of studies that have examined the efficacy of specific psychotherapies targeting drinking among patients with comorbid BPD; however, their efficacy in reducing BPD symptoms is unknown. There are also three psychotherapies that were specifically developed for patients with BPD and SUDs, but only one of these (Dynamic Deconstructive Psychotherapy) has been tested among patients with dual diagnoses of BPD and AUDs. Research on pharmacotherapy for dual diagnoses of BPD and AUD is scarce, and no study has yet explored medication options that can concurrently manage symptoms of BPD and decrease alcohol consumption. Interestingly, there is growing evidence that anticonvulsants and second generation antipsychotics, the recent medications of choice for the management of anger in BPD, may also reduce alcohol craving and consumption. Although premature, these findings are encouraging especially for this population of patients for whom treatment options are very limited.

Safety and drinking outcomes among patients with comorbid alcohol dependence and borderline personality disorder treated with high-dose baclofen

“…Moreover, the observed betweengroup differences in drinking outcomes could, in part, result from a lower efficacy of HDB in patients with BPD. This observation would be consistent with the fact that both antiepileptic and antipsychotic medications are occasionally considered to be more efficacious for comorbid BPD and alcohol dependence than the usual anticraving medications (Gianoli et al, 2012).…”

The prevalence of comorbid alcohol use disorder in the presence of personality disorder: Systematic review and explanatory modelling

“…This question has not been thoroughly addressed and requires examination. This problem has, however, been recognized by some PD experts with an interest in treatment interventions for comorbid substance use disorders . Interestingly dialectical behaviour therapy, arguably the most studied intervention for PD, has been examined in other substance use disorders but not AUD, the commonest and most easily accessible psychoactive drug.…”

Application of EMDR Therapy for Borderline Personality Disorder

“…Despite the present difficulties in directly identifying genetic and biological factors in persons with BPD, these aspects are relevant to a discussion of EMDR case conceptualization and for optimizing pharmacological treatment, which frequently is a necessary parallel approach in persons with BPD. See Gianoli, Jane, O'Brien, and Ralevski (2012) and Lieb, Völlm, Rücker, Timmer, and Stoffers (2010) for recent reviews of pharmacotherapy for persons with BPD. EMDR may provide an interesting tool to assist in discriminating the role of these early experiences in clients' present problems, as Shapiro (2010) remarked.…”