The Impact of psychotherapy on Comorbid Borderline Personality Disorder and Substance Use Disorder: A Systematic Review

Background: Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD) frequently co-occur, mutually influencing each other due to shared traits like affective instability and impulsivity. This high comorbidity presents significant challenges for mental health and addiction professionals, as it leads to high dropout rates and relational issues that undermine therapeutic alliances and the achievement of therapeutic goals. Consequently, there is no consensus on the most effective psychological treatment approaches. This review aims to evaluate the advances made in the past decade in treating individuals with concurrent BPD and SUD, focusing on the impact of current psychological therapies.
Method: Using the PRISMA protocol, searches were conducted in Scopus, PubMed, and PsycINFO. Following the establishment of inclusion and exclusion criteria and a thorough screening process, 18 studies were selected for review.
Results: Current interventions demonstrate improvements in quality of life and reductions in borderline personality symptoms over time. However, the findings regarding the reduction of substance use are less conclusive, and treatment adherence remains a significant challenge. Patients generally view current therapies favorably, emphasizing the importance of direct, clear, and sincere communication from therapists, a strong therapeutic alliance, and the inclusion of specialized group therapies, among other factors.
Conclusions: While the results are promising, they should be interpreted with caution. Further research is needed to develop integrative therapies that address the complexity of these co-occurring disorders to optimize therapeutic outcomes.