Substance Use Comorbidities

Abstract

This case illustrates key principles of treating patients with borderline personality disorder (BPD) and comorbid substance use. Chief among these is to consider whether substance use occurs within the BPD framework of interpersonal hypersensitivity. Patients who meet the diagnostic threshold for an independent substance use disorder may require concurrent substance treatment. Effective techniques to address substance use, such as motivational interviewing and referral to 12-step programs, can readily be integrated into treatment for BPD. Sustained sobriety, or engagement in substance treatment, are not prerequisites for participation in treatment for BPD but is often necessary to its success. Another key principle is to ensure that treatment is guided by the patient’s goals and values. This will maximize initial motivation, and if motivation wanes, knowing the patient’s goals and values gives the therapist a ready-made intervention. A further key principle is that you can expect risky or reckless behaviors, once treated, to resurface in different forms, until the underlying interpersonal hypersensitivity is better managed.