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Published Date: 4 February 2025

Enhancing the Social Network: Multimodal Treatment for Comorbid Borderline Personality Disorder and Alcohol Use Disorder

Abstract

More than half of all people with borderline personality disorder will develop alcohol use disorder in their lifetime. These disorders mutually reinforce each other, with a higher risk for treatment failure and poor outcomes, including suicide, yet no widely available treatments have been found to be effective for both diagnoses concurrently, leaving patients and clinicians alike stranded between two clinical domains that rarely overlap despite shared features. In the absence of alternatives, good psychiatric management (GPM) capitalizes on standard-of-care interventions using generic clinical tools that do not require specialization. In an effort to broaden and stabilize the social networks of connections for patients with interpersonal hypersensitivity, GPM relies on a multimodal approach that combines the indicated pharmacological and psychosocial interventions for the treatment of alcohol use disorder with a common-factors approach for borderline personality disorder. This multimodal approach emphasizes psychoeducation, social rehabilitation, management of suicidality, and active management of these frequently comorbid conditions. In this article, the authors describe GPM’s strategy of stabilizing and broadening the patient’s social network to target the core interpersonal and stress hypersensitivity. To do this, clinicians can use interventions for significant others combined with empirically supported and widely available mutual-help groups, such as Alcoholics Anonymous, that structure and regulate relational instabilities with community norms, standards, roles, and procedures. GPM also promotes family interventions for both conditions to reduce conflict and increase support within existing relationships, thereby strengthening patients’ capacity to work on their sobriety and borderline personality disorder by mitigating aloneness and its effects.

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Information & Authors

Information

Published In

Go to American Journal of Psychotherapy
Go to American Journal of Psychotherapy
American Journal of Psychotherapy
Pages: 55 - 62
PubMed: 39901760

History

Received: 1 November 2023
Revision received: 25 October 2024
Accepted: 5 November 2024
Published online: 4 February 2025
Published in print: March 01, 2025

Keywords

  1. Borderline Personality Disorder
  2. Alcohol Use Disorder
  3. Good Psychiatric Management
  4. Social Networks
  5. Mutual-Help Groups

Authors

Details

Edward H. Patzelt, Ph.D. edward.patzelt@gmail.com
Patzelt Psychology PLLC, Boston (Patzelt); Department of Psychiatry, Brigham and Women’s Hospital, Boston (Conway), and Department of Psychiatry, Harvard Medical School, Boston (Conway, Choi-Kain); Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts (Mermin, Jurist, Choi-Kain).
Stephen Conway, M.D.
Patzelt Psychology PLLC, Boston (Patzelt); Department of Psychiatry, Brigham and Women’s Hospital, Boston (Conway), and Department of Psychiatry, Harvard Medical School, Boston (Conway, Choi-Kain); Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts (Mermin, Jurist, Choi-Kain).
Sam A. Mermin, B.A.
Patzelt Psychology PLLC, Boston (Patzelt); Department of Psychiatry, Brigham and Women’s Hospital, Boston (Conway), and Department of Psychiatry, Harvard Medical School, Boston (Conway, Choi-Kain); Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts (Mermin, Jurist, Choi-Kain).
Julia Jurist, B.A.
Patzelt Psychology PLLC, Boston (Patzelt); Department of Psychiatry, Brigham and Women’s Hospital, Boston (Conway), and Department of Psychiatry, Harvard Medical School, Boston (Conway, Choi-Kain); Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts (Mermin, Jurist, Choi-Kain).
Lois W. Choi-Kain, M.D., M.Ed.
Patzelt Psychology PLLC, Boston (Patzelt); Department of Psychiatry, Brigham and Women’s Hospital, Boston (Conway), and Department of Psychiatry, Harvard Medical School, Boston (Conway, Choi-Kain); Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts (Mermin, Jurist, Choi-Kain).

Notes

Send correspondence to Dr. Patzelt (edward.patzelt@gmail.com).

Competing Interests

Dr. Choi-Kain receives book royalties from American Psychiatric Association Publishing and Springer Publishing, provides ongoing consultation with Tetricus Labs, and consulted for a Boehringer Ingelheim project. The other authors report no financial relationships with commercial interests.

Funding Information

This work was funded by an anonymous donation to the Gunderson Personality Disorders Institute.

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