Borderline Personality Disorder: Practical Treatment Strategies for Addiction Clinicians (On-Demand)-BPD2026

Video Transcription

Video Summary

The webinar, part of the American Academy of Addiction Psychiatry’s Advanced Addiction Psychotherapy series, focused on treating patients with co-occurring borderline personality disorder (BPD) and substance use disorders (SUD). Dr. Rocco Iannucci opened with background on why this topic matters: BPD and SUD frequently overlap in clinical settings, worsen each other’s prognosis, and increase risks such as suicide, overdose, and functional impairment. He reviewed treatment foundations, emphasizing patience, retention, and avoiding iatrogenesis, especially polypharmacy and emotionally reactive care.<br /><br />He highlighted evidence-based psychotherapies for BPD, including DBT, mentalization-based therapy, schema therapy, and dynamic deconstructive psychotherapy, and noted that several have been adapted for co-occurring SUD. Clinical trial findings suggested that structured therapies can reduce both BPD and substance-related symptoms, though outcomes vary. He then described good psychiatric management (GPM) as a flexible, practical model that can be integrated into general addiction care. GPM emphasizes collaboration, transparent diagnosis-sharing, psychoeducation, realistic hope, safety planning, team communication, and “split treatment, but not splitting.”<br /><br />Dr. Caroline Ferreira presented a case of “Mr. D,” a man with alcohol use disorder and BPD who initially rejected the diagnosis. She showed how GPM helps clinicians frame symptoms as understandable responses to interpersonal sensitivity, use careful language to reduce stigma, manage ambivalence with motivational interviewing, and involve family in psychoeducation and safety planning. The discussion ended with advice on managing clinician reactivity, grounding, supervision, and using structure and curiosity to maintain therapeutic effectiveness.

Keywords

borderline personality disorder

substance use disorders

good psychiatric management

dialectical behavior therapy

co-occurring disorders

addiction psychotherapy

psychoeducation

motivational interviewing

safety planning

polypharmacy

clinical case

therapeutic alliance

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