Kienast Thorsten, Foerster Julia
Department of Psychiatry and Psychotherapy, Charité - University Medical Center Berlin, Charité Campus Mitte, Berlin, Germany.
Curr Opin Psychiatry. 2008 Nov;21(6):619-24. doi: 10.1097/YCO.0b013e32830d365c.
Psychotherapy of patients with personality disorder and concomitant substance dependence requires an integrative approach. Although a number of studies have evaluated psychotherapy for one of these disorders, only few studies have described the effectiveness of treatment programs in comorbid patients. These limited findings provide a basis for the further development of treatments for personality disorder and concomitant substance dependence. This review gives an overview of the current state of research in this field.
Although a large number of evaluation studies tested the effectiveness of several therapies for alcohol dependence, far fewer evaluated nonalcohol substance dependence. There are very few evaluations of the efficacy of psychotherapy for other forms of drug dependence. Only dialectical behavior therapy and dual-focus schema therapy have been tested for the treatment of personality disorder and substance dependence.
To date, two randomized controlled trials in 59 female-only patients with borderline personality disorder and substance abuse provided the best evidence-based data for the effectiveness of dialectical behavior therapy. For dual-focus schema therapy, a single randomized controlled trial indicated a curative effect in a small group of patients with personality disorder and substance dependence. Although the results of these studies are encouraging, further clinical trials need to be conducted in larger populations including male participants.
对患有边缘性人格障碍且伴有物质依赖的患者进行心理治疗需要采用综合方法。尽管有许多研究评估了针对其中一种障碍的心理治疗，但只有少数研究描述了治疗方案对共病患者的有效性。这些有限的研究结果为进一步开发针对边缘性人格障碍和物质依赖的治疗方法提供了基础。本综述概述了该领域的当前研究状况。
尽管大量评估研究测试了几种疗法对酒精依赖的有效性，但评估非酒精物质依赖的研究要少得多。对其他形式药物依赖的心理治疗效果评估非常少。只有辩证行为疗法和双焦点图式疗法针对边缘性人格障碍和物质依赖的治疗进行了测试。
迄今为止，两项针对仅59名患有边缘性人格障碍和物质滥用的女性患者的随机对照试验为辩证行为疗法的有效性提供了最佳循证数据。对于双焦点图式疗法，一项随机对照试验表明在一小群患有边缘性人格障碍和物质依赖的患者中有治愈效果。尽管这些研究结果令人鼓舞，但需要在包括男性参与者在内的更大人群中进行进一步的临床试验。
