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Treatment professionals must be cognizant of the unique challenges facing this population of addicts, and must have specific programming set up to meet the unique needs of the borderline personality patient.

An increased risk of suicide, trust issues, the necessity of additional pharmacological therapy, decreased cognitive compliance and family support complications all need to be addressed for optimal treatment. Long term and intensive continuing aftercare will generally be required, and there will best be a single case manager overseeing all clinicians and health care workers employed on the treatment of the borderline personality patient in drug rehab.

Patients with borderline personality disorder are at a very high risk for substance abuse behaviors. Their frequent affective or mood fluctuations, plus their difficulties communicating and interacting in socially acceptable ways when coupled with a greatly decreased level of impulse control, make the use of drugs and the eventual addiction to drugs very common.

Although the treatment of borderline personality patients in drug rehab is very complicated and presents unique challenges, effective treatment is necessary for a number of reasons. Firstly, borderline personality patients concurrently abusing drugs or alcohol are at a significantly elevated risk for suicide, or other harmful behaviors (self mutilation, risky sex etc.). Secondly, when the already low levels of impulse controls are further diminished by intoxication, these patients are at great risk for provoking attacks upon their person, and can quite often become injured through their provocative behaviors.

Some special considerations for the drug rehab treatment of borderline personality disorder patients are increased suicide risks and thus a need for personal monitoring, a need for a comprehensive assessment period, the appointment of a specific case worker, appropriate pharmaceutical symptoms management, individual counseling with a professional familiar with the issues of borderline personality disorder, and long term continuing case management and aftercare.

Addiction Therapy

Although limited duration therapies have shown some promise, there is a consensus that for best effect, therapy needs to continue over the medium to long term, and the patient should maintain therapeutic involvement for years rather than months.

Group therapy

Group therapy is a very commonly employed therapeutic tool during a period of drug rehab, and research has shown that borderline personality disorder sufferers can also benefit from inclusion into group therapy, and through participation in 12 steps programs such as AA or NA.

If possible, a group of other borderline personality abusers is ideal, but when unavailable, a group of fellow recovering substance abusers is appropriate.

Individual therapy

Combined with appropriate pharmacological symptoms management, the use of ongoing psychotherapy has proven the most effective strategy for the treatment of borderline personality disorder recovering addicts. There are a number of unique issues that present when counseling a substance abusing borderline personality disorder patient, and as such any professional employed for the counseling should have an awareness of the unique and pertinent issue to treatment.

A hallmark of the disorder is an inability to trust, and this can limit the effectiveness of one on one therapy. To best earn trust, there should be an explicit discussion of the roles and aims of the therapy, and an agreement of these roles.

The presentation of cognitive dichotomies or splitting ideations is another hallmark of the disorder. People are generally seen as all good or all bad, and there is little grey area between the two. The therapist needs to be aware of splitting ideations, and be aware of splitting ideation as it may relate to members of the therapeutic team. As a relapse prevention strategy, therapists need to work with the patients to decreases this extreme dichotomy of thinking, and to encourage the consideration of the real complexities and gray areas of both people and situations.

Impulse control difficulties increases the likelihood of relapse and as a strategy of relapse management, therapists should encourage introspection and consideration in exchange for impulsive or knee jerk reactions.

Disease education

Many patients benefit from and appreciate some form of disease education and symptoms management instruction. Education can include how best to understand and control symptoms, as well as strategies for relapse prevention, and general work training and other life skills courses.

Family involvement

Family involvement in drug rehab is normally very beneficial to both the recovering addict and as well to the family, and this may or may not be true when considering the unique needs of the recovering borderline personality disorder patient in drug rehab. An evaluation of the relationship between the recovering addict and the family should be made before determining whether familial involvement is likely to promote healing or to induce further destructive behaviors. When appropriate, such as when the family maintains a continuing relationship with the borderline personality disorder addict, either financially or socially, the involvement of the family can be beneficial. Family can learn more about the disease, and the interaction of the psychological symptoms with substance abuse, and can learn the best strategies for long term support.

The impact on the family of substance abuse in a borderline personality disorder patient can be significant, and harmful, and this period of education and therapy can benefit the family greatly.

In Summary

Always beneficial, long term aftercare needs to be considered of vital importance for the continued abstinence promotion of recovering borderline personality disorder patients.

The case management team should continue to intervene in the recovering addict's life both to prevent relapse, as well as to prevent other socially or personally destructive behaviors; and the involvement in peer group sessions should be encouraged. Most importantly, the continuation of intensive individual therapy needs to occur, and the continuing modifications of pharmacologic management as symptoms expressions change.

Although drug rehab for borderline personality disorder patients can be increasingly complex, a comprehensive and tailored therapeutic strategy can induce lasting behavioral change and sobriety. Any drug rehab facility for borderline personality disorder patients must be aware of the unique needs and demands of this sub group of people, and have appropriate case management skills and professionals employed in the therapy.

Treatment Aspects

An accurate picture of both the level of abuse and addiction as well the severity of behavioral symptoms needs to be attained before admission for the effective planning of treatment.

Borderline personality sufferers are notoriously untruthful when self reporting their levels of substance abuse and other behavioral problems, and as such the best way to obtain an accurate risk assessment is through the inclusion of all current and past community care and health workers assigned to the patient.

Because the care of the borderline personality patient generally involves a number of professionals working concurrently, the patient benefits most when a single case manger is appointed to make the ultimate decisions on assigned care and therapeutic protocols.

Suicide risks

Borderline personality disorder patients have an almost 10% chance of successfully committing suicide, and this risk is elevated through substance use and during periods of stress. Because the risk of suicide or self harmful behaviors is so high, the drug rehab staff must be aware of the risks and monitor carefully the behaviors of the patient during their stay. In extreme cases, pharmacological restraint may need to be administered in acute suicidal risk periods.

Pharmacological intervention for borderline personality disorder symptoms management

There are a number of pharmaceutical interventions employed depending on the severity of the disorder, and the sub type as presented. Patients with concurrent substance abuse generally present with an impulsive destructive type of borderline personality disorder, and for this subset, the use of SSRI's for impulse control and mood balancing has proven most beneficial. On a case by case basis the use of other anti depressant, anxiolitics and even neuroleptics or anti psychotics may be deemed appropriate.

Proper pharmaceutical intervention can have a very beneficial impact on symptoms expression, and can induce a much more receptive state of mind for drug dependence therapies and other interventions.

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Page last updated Oct 13, 2015

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