Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

616 V. TREATMENTS FOR ADDICTIONSules, and treatment strategies in DBT-SUD are outlined. For a comprehensivedescription of this treatment approach, interested readers are referred to theDBT treatment manual and group skills training manual (Linehan, 1993a,1993b) and the DBT-SUD treatment manual (Linehan, Dimeff, & Sayrs,2004).WHY IS A TREATMENT FOR SUBSTANCE USERSWITH BORDERLINE PERSONALITY DISORDER NEEDED?Separately, SUDs and BPD are serious public health problems associated withsignificant psychosocial impairment. Together, however, the combination ofBPD and SUD is associated with greater problems than substance abuse alone(Links, Heslegrave, Mitton, van Reekum, & Patrick, 1995). For example,substance users with personality disorders are at risk for poor treatment outcome(Moos, Moos, & Finney, 2001). The presence of BPD specifically maylead to a number of impediments in standard substance abuse treatments. Inone study, a diagnosis of BPD among opiate addicts treated with methadonepredicted greater psychiatric problems and alcoholism following treatment(Kosten, Kosten, & Rousaville, 1989). Between 5 and 32% of individualswith SUD meet criteria for BPD (Brooner, King, Kidorf, Schmidt, & Bigelow,1997; Weiss et al., 1993), and the two disorders often share core features(e.g., impulsivity; Trull, Sher, Minks-Brown, Durbin, & Burr, 2001). Theextension of DBT from clients with BPD to those with BPD and SUD can beattributed, in part, to the high severity and comorbidity of the two separatedisorders, along with the evidence that standard DBT is efficacious for individualswith BPD.TARGET POPULATION FOR DBT-SUDDBT-SUD was originally developed and tested with female clients meeting fulldiagnostic criteria for BPD and polysubstance abuse disorder or SUDs for opiates,cocaine, amphetamines, sedative/hypnotics, hallucinogens, or anxiolytics.Individuals with mental retardation, schizophrenia, schizoaffective disorder,bipolar affective disorder, and psychosis disorder not otherwise specified (NOS)have been excluded from studies evaluating the efficacy of DBT-SUD. As aresult, DBT-SUD has been tested in a relatively specific population. Althoughit may be impossible to limit the use of DBT-SUD to such a specific populationin clinical practice, it is recommended that DBT-SUD be used with clients similarto the population from DBT-SUD clinical trials, until future outcome studiessupport the efficacy of DBT-SUD in different populations.