Personality Disorders

  • Louisa M. C. van den Bosch
  • Roel Verheul


Subject of this chapter is the often found combination of personality disorders and ­substance abuse disorders. The serious nature of this comorbidity is shown through the discussion of prevalence and epidemiological data. Literature shows that the comorbidity, hampering the diagnostic process, is seen as complicating for treatment planning. Therefore, etiological models that explain the co-occurrence of both disorders are helpful. Several models, among them the Behavioral Disinhibition Pathway, the Stress Reduction Pathway, and the Reward Sensitivity Pathway are described. Next, treatment programs, focusing on one or on both disorders are described, and research results are shown. Finally, clinical implications are described. The most important conclusion drawn is that treatment of dually diagnosed patients with severe problems needs to include both foci, and because of that conclusion, therapists need to be trained to address a range of symptomatic manifestations of personality pathology in the impulse control spectrum.


Borderline Personality Disorder Personality Disorder Personality Disorder Dialectical Behavior Therapy Borderline Personality Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Special thanks to Rebecca Dulitt and Lisa Davies.


  1. 1.
    Verheul R, van den Brink W, Hartgers C. Personality disorders predict relapse in alcoholic patients. Addict Behav. 1998;23:869–82.PubMedGoogle Scholar
  2. 2.
    Zimmerman M, Coryell WH. DSM-III personality disorder diagnoses in a nonpatient sample: demographic correlates and comorbidity. Arch Gen Psychiatry. 1989;46:682–9.PubMedGoogle Scholar
  3. 3.
    Zanarini MC, Frankenburg FR, Dubo ED. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–9.PubMedGoogle Scholar
  4. 4.
    Toner BB, Gillies LA, Prendergast P, Cote FH, Browne C. Substance use disorders in a sample of Canadian patients with chronic mental illness. Hosp Commun Psychiatry. 1992;43(3):251–4.Google Scholar
  5. 5.
    Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States. Arch Gen Psychiatry. 2004;61:361–7.PubMedGoogle Scholar
  6. 6.
    Verheul R, Kranzler HR, Poling J. Axis I and Axis II disorders in substance abusers: fact or artifact? J Stud Alcohol. 2000;61:101–10.PubMedGoogle Scholar
  7. 7.
    Ministry of Health, the Netherlands. Multidisciplinary guideline personality disorders. Utrecht, the Netherlands: Trimbos Instituut; 2008.Google Scholar
  8. 8.
    Ross S, Dermatis H, Levounis P, Galanter M. A comparison between dually diagnosed inpatients with and without Axis II comorbidity and the relationship to treatment outcome. Am J Drug Alcohol Abuse. 2003;29(2):263–79.PubMedGoogle Scholar
  9. 9.
    Verheul R, van den Brink W. Substance abuse and personality disorders. In: Kranzler HR, Rounsaville BJ, editors. Dual diagnosis and treatment. New York: Marcel Dekker; 2000.Google Scholar
  10. 10.
    Pettinati HM, Pierce JD, Belden PP. The relationship of Axis II personality disorders to other known predictors of addiction treatment outcome. Am J Addict. 1999;8:136–47.PubMedGoogle Scholar
  11. 11.
    Goldstein RB, Compton WM, Pulay AJ, Ruan WJ, Pickering RP, Stinson FS, Grant BF. Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2007;90(2–3):145–58.PubMedGoogle Scholar
  12. 12.
    Fridell M, Hesse M, Billsten J. Criminal behavior in antisocial substance abusers between five and fifteen years follow-up. Am J Addict. 2007;16(1):10–4.PubMedGoogle Scholar
  13. 13.
    Fridell M, Hesse M. Psychiatric severity and mortality in substance abusers: a 15-year follow-up of drug users. Addict Behav. 2006;31(4):559–65.PubMedGoogle Scholar
  14. 14.
    Westermeyer J, Thuras P, Carlson G. Association of antisocial personality disorder with psychiatric morbidity among patients with substance use disorder. Subst Abus. 2005;26(2):15–24.PubMedGoogle Scholar
  15. 15.
    Murray MG, Anthenelli RM, Maxwell RA. Use of health services by men with and without antisocial personality disorder who are alcohol dependent. Psychiatr Serv. 2000;51(3):380–2.PubMedGoogle Scholar
  16. 16.
    Ladd GT, Petry NM. Antisocial personality in treatment-seeking cocaine abusers: psychosocial functioning and HIV risk. J Subst Abuse Treat. 2003;24(4):323–30.PubMedGoogle Scholar
  17. 17.
    Kelley JL, Petry NM. HIV risk behaviors in male substance abusers with and without antisocial personality disorder. J Subst Abuse Treat. 2000;19(1):59–66.PubMedGoogle Scholar
  18. 18.
    Cornelius JR, Reynolds M, Martz BM, Clark DB, Kirisci L, Tarter R. Premature mortality among males with substance use disorders. Addict Behav. 2008;33(1):156–60.PubMedGoogle Scholar
  19. 19.
    Moeller FG, Dougherty DM, Barratt ES, Oderinde V, Mathias CW, Harper RA, Swann AC. Increased impulsivity in cocaine dependent subjects independent of antisocial personality disorder and aggression. Drug Alcohol Depend. 2002;68(1):105–11.PubMedGoogle Scholar
  20. 20.
    Feske U, Tarter RE, Kirisci L, Pilkonis PA. Borderline personality and substance use in women. Am J Addict. 2006;15(2):131–7.PubMedGoogle Scholar
  21. 21.
    Darke S, Williamson A, Ross J, Teesson M, Lynskey M. Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Depend. 2004;74(1):77–83.PubMedGoogle Scholar
  22. 22.
    Welch SS, Linehan MM. High-risk situations associated with parasuicide and drug use in borderline personality disorder. J Pers Disord. 2002;16(6):561–9.PubMedGoogle Scholar
  23. 23.
    Links PS, Heslegrave RJ, Mitton JE, van Reekum R, Patrick J. Borderline personality disorder and substance abuse: consequences of comorbidity. Can J Psychiatry. 1995;40(1):9–14.PubMedGoogle Scholar
  24. 24.
    Miller FT, Abrams T, Dulit R, Fyer M. Substance abuse in borderline personality disorder. Am J Drug Alcohol Abuse. 1993;19(4):491–7.PubMedGoogle Scholar
  25. 25.
    Morgenstern J, Langenbucher J, Labouvie E, Miller KJ. The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables. J Abnorm Psychol. 1997;106(1):74–84.PubMedGoogle Scholar
  26. 26.
    Neufeld KJ, Kidorf MS, Kolodner K, van King L, Clark M, Brooner RK. Behavioral treatment for opioid-dependent patients with antisocial personality. J Subst Abuse. 2008;34(1):101–11.Google Scholar
  27. 27.
    Messina NP, Wish ED, Hoffman JA, Nemes S. Antisocial personality disorder and TC treatment outcomes. Am J Drug Alcohol Abuse. 2002;28(2):197–212.PubMedGoogle Scholar
  28. 28.
    Verheul R, van den Brink W, Koeter MWJ. Antisocial alcoholics show as much improvement at 14-month follow-up as non-antisocial alcoholics. Am J Addict. 1999;8:24–33.PubMedGoogle Scholar
  29. 29.
    Goldstein RB, Powers SI, McCusker J, Lewis BF, Bigelow C, Mundt KA. Antisocial behavioral syndromes among residential drug abuse treatment clients. Drug Alcohol Depend. 1999;53(2):171–87.PubMedGoogle Scholar
  30. 30.
    Grella CE, Joshi V, Hser YI. Followup of cocaine-dependent men and women with antisocial personality disorder. J Subst Abuse Treat. 2003;25(3):155–64.PubMedGoogle Scholar
  31. 31.
    Compton WM, Cottler LB, Ben-Abdallah A, Cunningham-Williams R, Spitznagel EL. The effects of psychiatric comorbidity on response to an HIV prevention intervention. Drug Alcohol Depend. 2000;58(3):247–57.PubMedGoogle Scholar
  32. 32.
    Penick EC, Powell BJ, Campbell J, Liskow BI, Nickel EJ, Dale TM, Thomas HM, Laster LJ, Noble E. Pharmacological treatment for antisocial personality disorder alcoholics: a preliminary study. Alcohol Clin Exp Res. 1996;20(3):477–84.PubMedGoogle Scholar
  33. 33.
    Cecero JJ, Ball SA, Tennen H, Kranzler HR, Rounsaville BJ. Concurrent and predictive validity of antisocial personality disorder subtyping among substance abusers. J Nerv Ment Dis. 1999;187(8):478–86.PubMedGoogle Scholar
  34. 34.
    Cacciola JS, Rutherford MJ, Alterman AI, McKay JR, Snider EC. Personality disorders and treatment outcome in methadone maintenance patients. J Nerv Ment Dis. 1996;184(4):234–9.PubMedGoogle Scholar
  35. 35.
    Cacciola JS, Rutherford MJ, Alterman AI, Snider EC. An examination of the diagnostic criteria for antisocial personality disorder in substance abusers. J Nerv Ment Dis. 1994;182(9):517–23.PubMedGoogle Scholar
  36. 36.
    Goldstein RB, Bigelow C, McCusker J, Lewis BF, Mundt KA, Powers SI. Antisocial behavioral syndromes and return to drug use following residential relapse prevention/health education treatment. Am J Drug Alcohol Abuse. 2001;27(3):453–82.PubMedGoogle Scholar
  37. 37.
    Asnaani A, Chelminski I, Young D, Zimmerman M. Heterogeneity of borderline personality disorder: do the number of criteria met make a difference?J Pers Disord. 2007;21(6):615–25.PubMedGoogle Scholar
  38. 38.
    Verona E, Sachs-Ericsson N, Joiner Jr TE. Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry. 2004;161(3):444–51.PubMedGoogle Scholar
  39. 39.
    Landheim AS, Bakken K, Vaglum P. Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics. Substance abusers treated in two counties in Norway. Eur Addict Res. 2003;9(1):8–17.PubMedGoogle Scholar
  40. 40.
    Pelissier BM, O’Neil JA. Antisocial personality and depression among incarcerated drug treatment participants. J Subst Abuse. 2000;11(4):379–93.PubMedGoogle Scholar
  41. 41.
    Verheul R, van den Bosch LMC, Ball SA. Substance abus. In: Oldham J, Skodol AE, Bender DS, editors. Textbook of personality disorders. Washington DC: American Psychiatric Publishing; 2005. p. 463–76.Google Scholar
  42. 42.
    Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, Dawson DA, Huang B, Stinson FS, Grant BF. The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend. 2008;92(1–3):27–36.PubMedGoogle Scholar
  43. 43.
    Skodol AE, Oldham JM, Gallaher PE. Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders. Am J Psychiatry. 1999;156:733–8.PubMedGoogle Scholar
  44. 44.
    Zimmerman M. Diagnosing personality disorders: a review of issues and research methods. Arch Gen Psychiatry. 1994;51:225–45.PubMedGoogle Scholar
  45. 45.
    Rounsaville BJ, Kranzler HR, Ball S. Personality disorders in substance abusers: relation to substance use. J Nerv Ment Dis. 1998;186:87–95.PubMedGoogle Scholar
  46. 46.
    Schuckit MA. The clinical implications of primary diagnostic groups among alcoholics. Arch Gen Psychiatry. 1985;42(11):1043–9.PubMedGoogle Scholar
  47. 47.
    Bernstein DP, Handelsman L. The neurobiology of substance abuse and personality disorders. In: Ratey J, editor. Neuropsychiatry of personality disorders. Cambridge: Blackwell Science; 1995.Google Scholar
  48. 48.
    Cloninger CR, Sigvardsson S, Bohman M. Childhood personality predicts alcohol abuse in young adults. Alcohol Clin Exp Res. 1988;12:494–505.PubMedGoogle Scholar
  49. 49.
    Damen KF, DeJong CA, Nass GC, VanderStaak CP, Breteler MH. Interpersonal aspects of personality disorders in opioid-dependent patients: the convergence of the ICL-R and the SIDP-IV. Eur Addict Res. 2005;11(3):107–14.PubMedGoogle Scholar
  50. 50.
    Finn PR, Sharkansky EJ, Brandt KM. The effects of familial risk, personality, and expectancies on alcohol use and abuse. J Abnorm Psychol. 2000;109:122–33.PubMedGoogle Scholar
  51. 51.
    Tarter RE, Vanyukov M. Alcoholism: a developmental disorder. J Consult Clin Psychol. 1994;62:1096–107.PubMedGoogle Scholar
  52. 52.
    Wills TA, Windle M, Cleary SD. Temperament and novelty seeking in adolescent substance use: convergence of dimensions of temperament with constructs from Cloninger’s theory. J Pers Soc Psychol. 1998;74:387–406.PubMedGoogle Scholar
  53. 53.
    Patrick CJ. Antisocial personality disorder and psychopathy. In: Lilienfeld SO, O’Donohue W, Fowler KA, editors. Personality disorders: toward the DSM-V. Thousand Oaks, CA: Sage; 2007.Google Scholar
  54. 54.
    Taylor J. Substance use disorders and Cluster B personality disorders: physiological, cognitive, and environmental correlates in a college sample. Am J Drug Alcohol Abuse. 2005;31(3):515–35.PubMedGoogle Scholar
  55. 55.
    Caspi A, Begg D, Dickson N. Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study. J Pers Soc Psychol. 1997;73:1052–63.PubMedGoogle Scholar
  56. 56.
    Masse LC, Tremblay RE. Behavior of boys in kindergarten and the onset of substance use during adolescence. Arch Gen Psychiatry. 1997;54:62–8.PubMedGoogle Scholar
  57. 57.
    Cohen P, Chen H, Crawford TN, Brook JS, Gordon K. Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug Alcohol Depend. 2007;88 suppl 1:S71–84.PubMedGoogle Scholar
  58. 58.
    Goldstein RB, Grant BF, Ruan WJ, Smith SM, Saha TD. Antisocial personality disorder with childhood- vs. adolescence-onset conduct disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Nerv Ment Dis. 2006;194(9):667–75.Google Scholar
  59. 59.
    James LM, Taylor J. Impulsivity and negative emotionality associated with substance use problems and Cluster B personality in college students. Addict Behav. 2007;32(4):714–27.PubMedGoogle Scholar
  60. 60.
    Conrod PJ, Pihl RO, Vassileva J. Differential sensitivity to alcohol reinforcement in groups of men at risk for distinct alcoholism subtypes. Alcohol Clin Exp Res. 1998;22:585–97.PubMedGoogle Scholar
  61. 61.
    Levenson RW, Oyama ON, Meek PS. Greater reinforcement from alcohol for those at risk: parental risk, personality risk, and sex. J Abnorm Psychol. 1987;96(3):242–53.PubMedGoogle Scholar
  62. 62.
    van den Bosch LMC, Koeter M, Stijnen T, Verheul R, van den Brink W. Sustained efficacy of dialectical behavior therapy for borderline personality disorder. Behav Res Ther. 2005;43:1231–41.PubMedGoogle Scholar
  63. 63.
    Robinson TE, Berridge KC. The neural basis of craving: an ­incentive-sensitization theory of addiction. Brain Res Rev. 1993;18:247–91.PubMedGoogle Scholar
  64. 64.
    Zuckerman M. Vulnerability to psychopathology: a biosocial model. Washington, DC: American Psychological Association; 1999. p. 255–317.Google Scholar
  65. 65.
    Khan AA, Jacobson KC, Gardner CO, Prescott CA, Kendler KS. Personality and comorbidity of common psychiatric disorders. Br J Psychiatry. 2005;186:190–6.PubMedGoogle Scholar
  66. 66.
    Schuckit MA, Klein J, Twitchell G. Personality test scores as predictors of alcoholism almost a decade later. Am J Psychiatry. 1994;151:1038–43.PubMedGoogle Scholar
  67. 67.
    Compton WM, Thomas YF, Stinson FS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64(5):566–76.PubMedGoogle Scholar
  68. 68.
    Siever LJ, Davis KL. A psychological perspective on the personality disorders. Am J Psychiatry. 1991;148:1647–58.PubMedGoogle Scholar
  69. 69.
    Zanarini MC. Borderline personality disorder as an impulse spectrum disorder. In: Paris J, editor. Borderline personality disorder: etiology and treatment. Washington, DC: American Psychiatric Press; 1993. p. 67–86.Google Scholar
  70. 70.
    Sakai JT, Stallings MC, Mikulich-Gilbertson SK, Corley RP, Young SE, Hopfer CJ, Crowley TJ. Mate similarity for substance dependence and antisocial personality disorder symptoms among parents of patients and controls. Drug Alcohol Depend. 2004;75(2):165–75.PubMedGoogle Scholar
  71. 71.
    Justus AN, Finn PR, Steinmetz JE. P300, disinhibited personality, and early-onset alcohol problems. Clin Exp Res. 2001;25:1457–66.Google Scholar
  72. 72.
    Cacciola JS, Alterman AI, Rutherford MJ, McKay JR, Mulvaney FD. The relationship of psychiatric comorbidity to treatment outcomes in methadone maintained patients. Drug Alcohol Depend. 2001;61(3):271–80.PubMedGoogle Scholar
  73. 73.
    Ball SA, Carroll KM, Canning-Ball M, Rounsaville BJ. Reasons for dropout from drug abuse treatment: symptoms, personality, and motivation. Addict Behav. 2006;31(2):320–30.PubMedGoogle Scholar
  74. 74.
    Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006;81(3):301–12.PubMedGoogle Scholar
  75. 75.
    Ralevski E, Ball S, Nich C, Limoncelli D, Petrakis I. The impact of personality disorders on alcohol-use outcomes in a pharmacotherapy trial for alcohol dependence and comorbid Axis I disorders. Am J Addict. 2007;16:443–9.PubMedGoogle Scholar
  76. 76.
    Havens JR, Cornelius LJ, Ricketts EP, Latkin CA, Bishai D, Lloyd JJ, Huettner S, Strathdee SA. The effect of a case management intervention on drug treatment entry among treatment-seeking injection drug users with and without comorbid antisocial personality disorder. J Urban Health. 2007;84(2):267–71.PubMedGoogle Scholar
  77. 77.
    Claus RE, Kindleberger LR. Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout. J Psychoactive Drugs. 2002;34:25–31.PubMedGoogle Scholar
  78. 78.
    Blondelle GCJ, Williams GL, van den Bosch LMC. ‘OPERANT MILIEU’ in een TBS-kliniek. MGv 2007;7/8(62):634–9.Google Scholar
  79. 79.
    Daughters SB, Stipleman BA, Sargeant MN, Schuster R, Bornovalova MA, Lejuez CW. The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout. J Subst Abuse Treat. 2008;34(2):157–64.PubMedGoogle Scholar
  80. 80.
    Hesse M. Antisocial personality disorder and retention: a systematic review. Int J Ther Support Org. 2006;27(4):495–504.Google Scholar
  81. 81.
    Krampe H, Wagner T, Stawicki S, Bartels C, Aust C, Kroener-Herwig B, Kuefner H, Ehrenreich H. Personality disorder and chronicity of addiction as independent outcome predictors in alcoholism treatment. Psychiatr Serv. 2006;57(5):708–12.PubMedGoogle Scholar
  82. 82.
    Miranda Jr R, Meyerson LA, Myers RR, Lovallo WR. Altered affective modulation of the startle reflex in alcoholics with antisocial personality disorder. Alcohol Clin Exp Res. 2003;27(12):1901–11.PubMedGoogle Scholar
  83. 83.
    Marmorstein NR, Iacono WG. Longitudinal follow-up of adolescents with late-onset antisocial behavior: a pathological yet overlooked group. J Am Acad Child Adolescent Psychiatry. 2005;44(12):1284–91.Google Scholar
  84. 84.
    Carballo JJ, Oqendo MA, Giner L, Zalsman G, Roche AM, Sher L. Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism. Int J Adolesc Med Health. 2006;18(1):15–9.PubMedGoogle Scholar
  85. 85.
    Carballo JJ, Oqendo MA, Garcia-Moreno M, Poza B, Giner L, Baca E, Zalsman G, Roche AM, Sher L. Demographic and clinical features of adolescents and young adults with alcohol-related disorders admitted to the psychiatric emergency room. Int J Adolesc Med Health. 2006;18(1):87–96.PubMedGoogle Scholar
  86. 86.
    Stepp SD, Trull TJ, Sher KJ. Borderline personality features predict alcohol use problems. J Pers Disord. 2005;19(6):711–22.PubMedGoogle Scholar
  87. 87.
    Bakken K, Landheim AS, Vaglum P. Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients. BMC Psychiatry. 2007;7:29.PubMedGoogle Scholar
  88. 88.
    Darke S, Ross J, Williamson A, Teesson M. The impact of borderline personality disorder on 12-month outcomes for the treatment of heroin dependence. Addiction. 2005;100(8):1121–30.PubMedGoogle Scholar
  89. 89.
    Fridell M, Hesse M, Johnson E. High prognostic specificity of antisocial personality disorder in patients with drug dependence: results from a five-year follow-up. Am J Addict. 2006;15(3):227–32.PubMedGoogle Scholar
  90. 90.
    van den Bosch LMC, Verheul R, van den Brink W. Substance abuse in borderline personality disorder: clinical and etiological correlates. J Pers Disord. 2001;15(5):416–24.PubMedGoogle Scholar
  91. 91.
    Verheul R, van den Bosch LMC, Koeter MWJ, de Ridder MAJ, Stijnen T, van den Brink W. Efficacy of dialectical behavior therapy: a Dutch randomized controlled trial. Br J Psychiatry. 2003;182:135–40.PubMedGoogle Scholar
  92. 92.
    Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001;158:36–42.PubMedGoogle Scholar
  93. 93.
    Bateman A, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008;165:556–9.Google Scholar
  94. 94.
    Ball SA. Manualized treatment for substance abusers with personality disorders: dual focus schema therapy. Addict Behav. 1998;23:883–91.PubMedGoogle Scholar
  95. 95.
    Ball SA, Young JE, Rounsaville BJ. Dual focus schema therapy vs. 12-step drug counseling for personality disorders and addiction: randomized pilot study. Paper presented at the ISSPD 6th International Congress of the Disorders of Personality, Geneva, Switzerland; 2000.Google Scholar
  96. 96.
    Ball SA, Cobb-Richardson P, Connolly AJ, Bujosa CT, O’Neall TW. Substance abuse and personality disorders in homeless drop-in centre clients: symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry. 2005;46:371–9.PubMedGoogle Scholar
  97. 97.
    Ball SA. Comparing individual therapies for personality disordered opioid dependent patients. J Pers Disord. 2007;21:305–21.PubMedGoogle Scholar
  98. 98.
    Linehan MM, Schmidt H, Dimeff LA. Dialectical behaviour therapy for patients with borderline personality disorder and drug-dependence. Am J Addict. 1999;8:279–92.PubMedGoogle Scholar
  99. 99.
    Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, Kivlahan DR. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend. 2002;67:13–26.PubMedGoogle Scholar
  100. 100.
    Gerra G, Leonardi C, D’Amore A, Strepparola G, Fagetti R, Assi C, Zaimovic A, Lucchini A. Buprenorphine treatment outcome in dually diagnosed heroin dependent patients: a retrospective study. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(2):265–72.PubMedGoogle Scholar
  101. 101.
    Preuss UW, Koller G, Barnow S, Eikmeier M, Soyka M. Suicidal behavior in alcohol- dependent subjects: the role of personality disorders. Alcohol Clin Exp Res. 2006;30(5):866–77.PubMedGoogle Scholar
  102. 102.
    Sher KJ, Trull TJ. Personality and disinhibitory psychopathology: alcoholism and antisocial personality disorder. J Abnorm Psychol. 1994;103:92–102.PubMedGoogle Scholar
  103. 103.
    Cottler LB, Campbell W, Krishna VA, Cunningham-Williams RM, Abdallah AB. Predictors of high rates of suicidal ideation among drug users. J Nerv Ment Dis. 2005;193(7):431–7.PubMedGoogle Scholar
  104. 104.
    Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161:2108–14.PubMedGoogle Scholar
  105. 105.
    Tidemalm D, Elofsson S, Stefansson CG, Waern M, Runeson B. Predictors of suicide in a community-based cohort of individuals with severe mental disorder. Soc Psychiatry Psychiatr Epidemiol. 2005;40(8):595–600.PubMedGoogle Scholar
  106. 106.
    Martino S, Carroll K, Kostas D, Perkins J, Rounsaville B. Dual diagnosis motivational interviewing: a modification of motivational interviewing for substance-abusing patients with psychotic disorders. J Subst Abuse Treat. 2002;23(4):297–308.PubMedGoogle Scholar
  107. 107.
    McKay JR. Is there a case for extended interventions for alcohol and drug use disorders? Addiction. 2005;100:1594–610.PubMedGoogle Scholar
  108. 108.
    Messina N, Farabee D, Rawson R. Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. J Consult Clin Psychol. 2003;71(2):320–9.PubMedGoogle Scholar
  109. 109.
    Linehan MM. Cognitive behavioral therapy of borderline personality disorder. New York: Guilford; 1993.Google Scholar
  110. 110.
    Young JE. Cognitive therapy for personality disorders: a schema-focused approach (Revised edition). Sarasota: Professional Resource Press; 1994.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Psychiatric Hospital de Gelderse RoosArnhemThe Netherlands
  2. 2.Centre of Specific PsychotherapyOegstgeestThe Netherlands
  3. 3.Department of Clinical PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Viersprong Institute for Studies on Personality Disorders (VISPD)Center of Psychotherapy DeHalsterenThe Netherlands

Personalised recommendations