Combining pharmacotherapy with psychotherapy for substance abusers with borderline personality disorder: strategies for enhancing compliance

DBT is a comprehensive, behaviorally oriented treatment designed for highly dysfunctional individuals meeting criteria for BPD. Many of these criteria are characteristic of drug abusers, and some of the problems encountered in treatment of drug abusers, especially when various treatments are combined, are similar. The basic armamentarium of the DBT therapist is the balancing of validation and acceptance treatment strategies with problem-solving procedures, including contingency management, exposure-based procedures, cognitive modification, and skills training. In addition, a number of specific strategies have been woven together to enhance compliance and to reduce the staff splitting that is so frequent with this population. Those described in this chapter include orienting and commitment strategies and the focus in DBT on reducing therapy-interfering behavior and on consultation with the client rather than with the client's network.