[Personality disorders and substance abuse disorders. Psychosocial strategies]

The article begin with a review of the high prevalence of concurrent mental illness and substance abuse disorders among general and clinical populations, highlighting the need for development of appropriate services to treat these persons. Several studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in substance abuse populations and vice versa. We review findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance abuse programs, and describe new programs that integrate both types of treatment at the clinical level. This is followed by a description of main difficulties to do with outcome and treatment retention. Finally, we review the effectiveness of several specific treatments programs within psychiatric care for patients who have a dual diagnosis of a severe personality disorder and a substance abuse disorder. Such programs include, brief integrated programs based on the disease-and-recovery model or on the cognitive-behavioral model, comprehensive integrated assertive programs and intensive partial hospitalization programs. We conclude, that although several program features appear to be associated with effectiveness, there is no clear evidence supporting an advantage of any type of program when co-occurring substance abuse with severe personality disorder. Implementation of new specialized services for dual disorders should be within the context of simple, well designed controlled studies.