Dual Diagnosis

WHAT IT FEELS LIKE - Borderline Personality Disorder

Many individuals diagnosed with substance abuse problems also experience other psychological disorders. "Borderline Personality Disorder (BPD)", "Bi-polar Disorder", "Schizophrenia","Depressive Disorders", "Post Traumatic Stress Disorder (PTSD)", and so on are examples of psychological disorder classifications; diagnoses given to individuals as assessed by a medical practitioner according to the DSM-V Guidelines (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). This book serves as a universal authority for psychiatric diagnosis. All Australian treatment recommendations, as well as payments by health care providers, are often determined by DSM classifications. 

Findings in Lewis et al., 2001 showed that one-third of the substance-abusing population meet the criteria for one of the psychiatric diagnoses. Among those with the diagnosis of alcoholism, almost half have a second psychiatric diagnosis. Phobias were particularly common among males, followed by depression, schizophrenia, panic and mania. For alcoholic women in this study, phobias and depression, followed by antisocial personality, panic, schizophrenia, and mania were the most prevalent. 

There is also a frequent relationship between substance abuse and suicide (Doweiko, 2011). Estimates are that approximately 25% of people diagnosed with a Substance Abuse/Substance Dependence classification, entering treatment have made a suicide attempt at some point in the past. Some of these cases would have a diagnoses of BPD, PTSD if not both.

In some cases it is the second psychiatric diagnosis that receives treatment depending on assessment and most problematic behaviour. Involvement of a qualified psychologist and/or physician to assist in diagnosis and providing treatment for these clients at an early stage is critical. So an individual may come into a psychiatric facility for their substance dependence problem for a detox which could well be followed up by an extended stay in a mood disorders unit to attend to the second psychiatric diagnosis following the detox period. This is where an outpatient DBT program can fit in for individuals - a group I facilitate every Tuesday.

Treatment Option - The use of Dialectical Behavioural Therapy (DBT).

DBT is a skills training program developed by Marcia Lineham and many treatment services offer this model of treatment to individuals having been diagnosed with Suicidality Risk and/or Borderline Personality Disorder ( BPD).  A number of studies have been conducted focusing on skills training with different populations. For example, DBT skills training has been shown effective with eating disorders, treatment-resistent depression, and a variety of other disorders. In Linehan's research, increases in use of skills mediates reductions in suicide attempts, non-suicidal self-injury/self harm, difficulties regulating emotions and interpersonal problems. A subset of skills was also added to treatment for problem drinking  and improved outcomes compared to a treatment with out the skills.

I make mention of this program in relation to substance abuse because it is common for clients who are assessed for the DBT program to have had a history of substance abuse in their teens and in to the early adult lives. It is sometimes one of the problematic behaviours of the past that they engaged in in order to alleviate their anxiety and alter negative mood and social inhibitions which often, unfortunately, lead to further problematic behaviours. 

Wesley Hospital Ashfield- Mood Disorders Unit runs a DBT Program with group skills taught to two groups on either a Tuesday or Thursday from 9:30am to 2:45pm. For more information about this program please call the hospital on 97161400 or myself on 0417724632 as I am the Therapy coordinator for the program and work in the hospital on Mondays and Tuesdays.

There are four primary DBT skills training modules: 

  • Mindfulness skills,
  • interpersonal effectiveness skills,
  • emotional regulation skills and
  • distress tolerance skills.

I incorporate these skills in to my private therapy with individuals to compliment the work they may be doing as a group in a DBT skills program.