As discussed in Chapter A2, the most common personality disorders seen in AOD services are BPD and ASPD and research regarding the treatment of co-occurring personality and AOD disorders has largely focused on these two conditions [162]. Experts suggest that treating both the personality and AOD use disorder simultaneously, using a combination of psychotherapy and pharmacotherapy to support reductions in, or the cessation of, AOD use may be the best approach, although research comparing this with other approaches is lacking [162, 1515]. Donald and colleagues [121] recommend a staged approach, in which the early phases of treatment concentrate on the stabilisation of AOD use and self-harming behaviours using a transdiagnostic approach that focuses on emotion regulation and impulsivity, followed by interventions that focus on issues relating to identity and the self.
Treatment options available include psychotherapy and pharmacotherapy, which may be supplemented by other interventions including e-health and telehealth interventions, physical exercise and complementary and alternative therapies (e.g., omega-3). The evidence base surrounding each of these treatment options with regards to the treatment of BPD and ASPD is discussed below.