Personality disorder and addiction

Abstract

Personality disorder and substance use disorder very commonly co-occur. Depending on the sample and setting, comorbid substance use disorder can be diagnosed in approximately every second patient suffering from a personality disorder. Comorbid personality disorder seems to be more prevalent in drug use disorder than in alcohol use disorder. The association between substance use disorder and borderline or antisocial personality disorder is particularly frequent. These comorbidities are generally characterised by severe addiction problems and by an unfavourable clinical course. The differential indication for the treatment of patients with personality disorder and comorbid substance use disorder is of particular importance. For most patients with personality disorders, psychotherapy is the treatment of choice. Pharmacotherapy is helpful in an acute crisis and for other comorbid psychiatric disorders such as depression and psychosis. Three different evidence-based psychotherapies have been examined for comorbid patients (dialectical behaviour therapy; dynamic deconstructive psychotherapy; dual-focused schema therapy). There have been no controlled trials of pharmacother-apy for patients with personality disorder and substance use disorder. In conclusion, the principle should generally be applied that the two disorders should be treated together. However, further research is needed to improve the specific treatment options for patients with personality disorder and substance use disorder.