Integrating personality functioning in brief psychotherapy for substance use disorders: a case study

A large treatment gap exists for substance use disorders (SUDs) in India. Among other factors, personality vulnerabilities are widely implicated in the initiation and maintenance of SUDs leading to poor outcomes. Available brief interventions do not adequately address this. Longer term therapies are resource intensive and therefore difficult to incorporate in tertiary care settings due to poor treatment provider-patient ratio. Further, trait-based and categorical models have limited application in brief psychotherapies. Core pathology seen across personality disorders such as the impairments in self and interpersonal functioning present as modifiable characteristic adaptations of more stable personality structures. Therefore, the present article attempts to explore the possibility of integrating the personality functioning model as proposed by the alternative model of personality disorders (AMPD) in the DSM-5, within brief psychotherapies for SUDs. Modifications to the routine treatment structure, assessment, formulation and content are suggested with a focus on personality functioning. The clinical utility of the level of personality functioning scale (LPFS) is also demonstrated using a brief case illustration. Further research is required to explore the feasibility and effectiveness of utilizing a personality functioning model among patients with SUDs in India.