Psychotherapy of personality disorders and concomitant substance dependence

Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder

Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.

Gestalt Therapy Applied: A Case Study with an Inpatient Diagnosed with Substance Use and Bipolar Disorders

AIM

The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where 'multimorbidities', and/or 'overdiagnosis' and/or 'diagnosis overlap' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the 'here and now'.

METHODS

I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt's 'here and now' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder.

RESULTS

After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the 'here and now' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

People with substance use disorder (where 'multimorbidities', 'overdiagnosis' or 'diagnosis overlap' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the 'here and now'. Gestalt therapy should not be regarded as a practitioner's toolbox but as a therapeutic process allowing awareness and I-boundaries development in the 'here and now' through authentic and genuine relationships. The therapist's awareness and contact with themselves and their environment are reflected in the therapist's relaxed but awake and aware state of mind as well as their wise, spontaneous and mindful approach.

Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence

AIM

To assess personality disorder (PD), emotional intelligence (EI), and locus of control of alcohol dependent (AD) patients and its comparison with normal controls.

MATERIALS AND METHODS

Based on purposive sampling technique, 33 AD patients were selected from the De-Addiction Ward of Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) and 33 matched normal subjects were selected from Ranchi and nearby places. Both the groups were matched on various sociodemographic parameters, that is, age, gender, and socioeconomic level. All participants were assessed with Millon Clinical Multiaxial Inventory-III, Mangal EI Inventory, and Locus of Control scale. Obtained responses were scored by using standard scoring procedures and subsequently statistically analyzed by using Chi-square test.

RESULTS

AD patients have more comorbid pathological personality traits and disorders in comparison to their normal counterparts. Depressive, narcissistic, and paranoid PDs were prominent among AD group; followed by schizotypal, antisocial, negativistic, dependent, schizoid, sadistic, masochistic, and borderline PD. In comparison to normal participants, AD patients were significantly deficient in almost all the areas of EI and their locus of control was externally oriented.

CONCLUSION

Patients with AD have significantly higher PDs, low EI, and an external orientation on the locus of control. Identification and management of these comorbid conditions are likely to improve the management and outcome of AD.

Randomized trial of dual-focused vs. single-focused individual therapy for personality disorders and substance dependence

We conducted a randomized comparison of dual-focus schema therapy with individual drug counseling as enhancements to the residential treatment of 105 substance-dependent patients with specific personality disorders versus those without. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using the Cox proportional hazards model, we found no psychotherapy differences in retention (days in treatment). Hierarchical linear modeling indicated that participants with personality disorders started with higher psychiatric, interpersonal, and dysphoria symptoms and that both therapies reduced symptoms in 6 months. Contrary to predictions, individual drug counseling resulted in more sustained reductions than did dual-focus schema therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms.