Patients With Addiction and Personality Disorder: Treatment Outcomes and Clinical Implications

Louisa MC Van den Bosch; Roel Verheul


Curr Opin Psychiatry. 2007;20(1):67-71. 

In This Article

Abstract and Introduction


Purpose of Review: The present review examines the outcomes of treatments focusing on substance abuse, on personality disorders, and on both the foci simultaneously. Clinical guidelines for the treatment of dually diagnosed patients are described.
Recent Findings: Recent studies continued the tradition of examining the importance of factors such as the chronicity of substance abuse and the impact of sex with regard to the prognosis of the treatment of substance abuse and the development of effective treatment programs. Overall, the multifaceted and risky nature of dual problems is stressed, and as a logical consequence, an early detection of dual problems is promoted. Several studies show the risk of suicidal and harmful behavior associated with this population, even when the treatment for substance abuse has been successful. For the first time, the issue of dropout is studied from the client's perspective.
Summary: Knowledge about the effectiveness of dually focused treatments is emerging. Results show that the treatment of dually diagnosed patients with severe problems needs to include both the foci because it leads to enormous gains for the patients when personality disorders are also addressed. Yet, integrated treatment programs are lacking and research is still too limited.


Since the introduction of Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980, there has been a growing interest in the study of Axis II comorbidity among patients with substance use disorders (SUD). The driving force behind this study has been, and still is, the high comorbidity, along with the overall clinical pessimism about the prognosis, and the difficulties in the clinical management of the dually diagnosed patients.

Although the evaluation of co-occurring personality disorders has been the subject of numerous studies by addiction researchers, very little attention is paid on the co-occurrence of substance abuse by personality disorder researchers. This state of affairs is difficult to understand when one considers that substance abuse and personality disorders are by far the most common forms of dual diagnosis.


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