Patients with addiction and personality disorder: Treatment outcomes and clinical implications.
OBJECTIVE
The present review examines the outcomes of treatments focusing on substance abuse, on personality disorders, and on both the foci simultaneously. Clinical guidelines for the treatment of dually diagnosed patients are described.


RESULTS
Recent studies continued the tradition of examining the importance of factors such as the chronicity of substance abuse and the impact of sex with regard to the prognosis of the treatment of substance abuse and the development of effective treatment programs. Overall, the multifaceted and risky nature of dual problems is stressed, and as a logical consequence, an early detection of dual problems is promoted. Several studies show the risk of suicidal and harmful behavior associated with this population, even when the treatment for substance abuse has been successful. For the first time, the issue of dropout is studied from the client's perspective.


CONCLUSIONS
Knowledge about the effectiveness of dually focused treatments is emerging. Results show that the treatment of dually diagnosed patients with severe problems needs to include both the foci because it leads to enormous gains for the patients when personality disorders are also addressed. Yet, integrated treatment programs are lacking and research is still too limited.
van den Bosch
Louisa Mc
LM
Forensic Psychiatric Institute Oldenkotte, Rekken, The Netherlands. wiesvdbosch@planet.nl
Verheul
Roel
R
D003131:Combined Modality Therapy; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D011379:Prognosis; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome