Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder.
We conducted a randomized controlled trial to evaluate whether dialectical behavior therapy (DBT), a treatment that synthesizes behavioral change with radical acceptance strategies, would be more effective for heroin-dependent women with borderline personality disorder (N = 23) than Comprehensive Validation Therapy with 12-Step (CVT + 12S), a manualized approach that provided the major acceptance-based strategies used in DBT in combination with participation in 12-Step programs. In addition to psychosocial treatment, subjects also received concurrent opiate agonist therapy with adequate doses of LAAM (thrice weekly; modal dose 90/90/130 mg). Treatment lasted for 12 months. Drug use outcomes were measured via thrice-weekly urinalyses and self-report. Three major findings emerged. First, results of urinalyses indicated that both treatment conditions were effective in reducing opiate use relative to baseline. At 16 months post-randomization (4 months post-treatment), all participants had a low proportion of opiate-positive urinalyses (27% in DBT; 33% in CVT + 12S). With regard to between-condition differences, participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT + 12S significantly increased opiate use during the last 4 months of treatment. Second, CVT + 12S retained all 12 participants for the entire year of treatment, compared to a 64% retention rate in DBT. Third, at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT + 12S.
Linehan
Marsha M
MM
Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA. linehan@u.washington.edu
Dimeff
Linda A
LA
Reynolds
Sarah K
SK
Comtois
Katherine Anne
KA
Welch
Stacy Shaw
SS
Heagerty
Patrick
P
Kivlahan
Daniel R
DR
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001883:Borderline Personality Disorder / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008692:Methadyl Acetate / Q000008:administration & dosage; D010043:Outcome and Process Assessment, Health Care; D010352:Patient Dropouts / Q000523:psychology; D011613:Psychotherapy / Q000379:methods*; D012657:Self-Help Groups; D015813:Substance Abuse Detection
D008692:Methadyl Acetate