The 24-year course of substance use disorders in patients with borderline personality disorder and personality-disordered comparison subjects.

BACKGROUND AND OBJECTIVES

The purpose of this study is to detail the long-term course of substance use disorders (SUDs) among patients with borderline personality disorder (BPD) and subjects with other personality disorders (OPD).

METHODS

Two hundred and ninety patients with BPD and 72 subjects with OPD were assessed at baseline and 12 contiguous waves of follow-up as part of the McLean Study of Adult Development (MSAD). The SCID-I for DSM-III-R Axis I disorders was administered 13 times (at baseline admission and at 12 follow-up periods). Kaplan-Meier analyses were used to assess time-to-remission (2-12 years in length), time-to-recurrence (2-12 years after first remission), and cumulative time-to-new onsets of alcohol and drug use disorders.

RESULTS

Both study groups achieved high rates of remission (ranging from 12-year long to 2-year long) from alcohol use disorder (AUD) (BPD: 64%-91%; OPD: 80%-100%) and drug use disorder (DUD) (BPD: 71%-100%; OPD: 75%-100%). Recurrences (following 12-year long and 2-year long remissions) of AUD (BPD: 24%-63%; OPD: 46%-70%) and DUD (BPD: 28%-67%; OPD: 0%-38%) were not uncommon. Cumulative rates of new onsets during the 24 years of prospective follow-up of AUD (BPD: 5%-27%; OPD: 2%-10%) and DUD (BPD: 5%-21%; OPD: 7%-18%) were less common.

DISCUSSION AND CONCLUSIONS

Remissions of alcohol and drug use disorders among borderline patients are very common but recurrences are not uncommon. Results also suggest that new onsets of these disorders are relatively rare.

SCIENTIFIC SIGNIFICANCE

The course of SUDs in those with BPD is more complex than found in prior shorter-term studies.