In general, there is relatively little research to guide treatment for co-occurring personality disorders and AOD use disorders. The first line of treatment for those with co-occurring BPD and AOD use should be psychotherapy, with several interventions having been examined among people with co-occurring BPD and AOD use. Similarly, psychological interventions should be the first line of treatment for those with co-occurring ASPD and AOD use, although the available evidence is less well-developed. Without evidentiary support, pharmacological intervention is not recommended for the treatment of either co-occurring BPD and AOD use, or ASPD and AOD use, highlighting the need for further well-conducted studies to be undertaken in this area.
Box 22 illustrates the continuation of case study I, following Mira’s story. As illustrated, it may be necessary to plan treatment over the long-term and coordinate between multiple services in the delivery of care to a person with co-occurring personality disorders and AOD use disorders.
Box 22: Case study I: Treating co-occurring BPD and AOD use: Mira’s story continued
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Case study I: Mira’s story continued
The AOD worker immediately noted Mira’s high risk of overdose and organised for Mira to have naloxone training, which she had never had previously, as well as several take-home naloxone kits. The AOD worker also liaised with probation and parole. As part of the new program, Mira underwent comprehensive medical and psychological assessment, where she was also diagnosed with Hepatitis C. Mira immediately began direct-acting antiviral treatment.
As Mira’s medical needs were being addressed and she began to physically feel better, she told her AOD worker that she didn’t want to keep going the way she has been and end up back in prison – she wanted to change. The AOD worker organised for Mira to be put on the wait list for a local DBT-S program. Mira initially didn’t attend, but using MI techniques, the AOD worker helped Mira remember why attending was so important to her, and she started attending her appointments regularly. Mira’s AOD worker continued to provide support along with strategies on emotion regulation and relapse prevention. While there were several setbacks, Mira remained committed to her treatment plan.
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Key Points
- Both the BPD and AOD use should be addressed concurrently, and the approaches carefully coordinated.
- The need for multi-agency cooperation and information sharing is important and, in the case of co-occurring disorders, interventions need to be planned over months and years rather than weeks.