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Borderline Personality Disorder: Practical Treatme ...
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This webinar from the Advanced Addiction Psychotherapy Curriculum Series reviews practical treatment strategies for patients with borderline personality disorder (BPD) and co-occurring substance use disorders (SUDs). It emphasizes that BPD and SUD frequently overlap, and that their combination is associated with poorer remission, greater dysfunction, and higher suicide risk than either disorder alone.<br /><br />The presentation highlights several treatment principles: expect slow progress, prioritize patient engagement and retention, follow evidence-based standards of care, and avoid iatrogenic harm such as emotionally driven clinical reactions. For BPD, structured psychotherapy is the primary treatment; for SUD, evidence-based psychotherapy and, when appropriate, medications are important adjuncts. Common medications for alcohol, opioid, and tobacco use disorders are reviewed, along with harm-reduction tools such as naloxone and fentanyl/xylazine test strips.<br /><br />The talk also summarizes evidence for structured therapies used with BPD-SUD populations, including Dialectical Behavior Therapy (DBT), Dynamic Deconstructive Psychotherapy (DDP), Dual-Focus Schema Therapy (DFST), Mentalization-Based Therapy, and Good Psychiatric Management (GPM). Across studies, these approaches can improve BPD symptoms, psychiatric symptoms, retention, and some substance-related outcomes.<br /><br />A major focus is Good Psychiatric Management for Alcohol Use Disorder (GPM-AUD), which integrates psychoeducation, a real and collaborative therapeutic relationship, accountability, flexible treatment planning, safety planning, family involvement, and careful use of medications. A clinical case illustrates how GPM can help patients who initially reject a BPD diagnosis become more engaged by framing symptoms in plain language and focusing on usefulness rather than labels.<br /><br />Overall, the webinar presents BPD-SUD treatment as a structured but flexible process centered on alliance, validation, relapse prevention, and helping patients build a life outside of treatment.
Keywords
borderline personality disorder
substance use disorders
dual diagnosis
dialectical behavior therapy
good psychiatric management
harm reduction
naloxone
relapse prevention
psychoeducation
structured psychotherapy
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