Good Psychiatric Management for Borderline Personality Disorder and Alcohol Use Disorder

"Borderline personality disorder (BPD) and alcohol use disorder (AUD) co-occur quite often. Nearly half of all patients meeting diagnostic criteria for BPD have a concurrent AUD, and more than half will have AUD sometime in their life. Yet no integrated treatments for this common set of conditions have been adequately tested or disseminated. While still among the most stigmatized disorders in psychiatry and medicine at large, BPD's prognosis has been radically transformed; despite the longstanding belief that it was not treatable, we now know that it is highly likely to remit over time and is responsive to numerous evidence-based psychotherapies. Alcohol use combines with the vulnerabilities of BPD bidirectionally to compound disabling symptoms, increase risk for death by suicide, and render treatment more challenging. But, like BPD, AUD is treatable. These facts about BPD and AUD make obvious the need for combined intervention. Good Psychiatric Management for Borderline Personality Disorder and Alcohol Use Disorder provides education and a general approach to clinical management. Good psychiatric management's (GPM's) multimodal approach naturally incorporates medication, individual therapies, clinical case management, family work, and mutual help groups. BPD and AUD share core features of diminished neurocognitive and emotional processing capacity and insufficient agency, self-esteem, and coherent sense of self, and they are both associated with diminished social networks. Multimodal treatment broadens social networks (multiple clinical professionals providing care alongside loved ones) to reduce risk factors for relapse, increase support, and enhance recovery from both disorders. Treatment emphasizes the development of different coping responses and more effective prosocial behaviors that are more likely to generate the interpersonal responses needed to build health in sense of self and relationships. GPM uses motivational interviewing that focuses on drinking behaviors as well as self-destructive behaviors related to BPD. This generalist intervention is meant to be "good enough," in the spirit of pediatrician and psychoanalyst Donald Winnicott discussing normal developmental transformations. GPM encourages clinicians to gradually foster tolerable challenges for patients in their lives outside of treatment so that they can develop a sense of capability to manage those challenges on their own"--