Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder

Linehan, Marsha M; Dimeff, Linda A; Reynolds, Sarah K; Comtois, Katherine Anne; Welch, Stacy Shaw; Heagerty, Patrick; Kivlahan, Daniel R

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Volume 67, Issue 1 , Pages 13-26, 1 June 2002

Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder

Marsha M Linehan
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA
- Corresponding author. Tel.: +1-206-543-9886; fax: +1-206-616-1513
Linda A Dimeff
- The Behavioral Technology Transfer Group, 4556, University Way, College Center Building, Suite 222, Seattle, WA 98105, USA
- Tel.: +1-206-675-8588; fax: +1-206-675-8590.
Sarah K Reynolds
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA
Katherine Anne Comtois
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA
Stacy Shaw Welch
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA
Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA 98195-7232, USA
- Tel.: +1-206-616-2720; fax: +1-206-616-2724.
Daniel R Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98108-8280, USA
- Tel.: +1-206-764-2457; fax: +1-206-764-2293.

Received 9 July 2001; received in revised form 30 December 2001; accepted 10 January 2002.

Abstract

We conducted a randomized controlled trial to evaluate whether dialectical behavior therapy (DBT), a treatment that synthesizes behavioral change with radical acceptance strategies, would be more effective for heroin-dependent women with borderline personality disorder (N=23) than Comprehensive Validation Therapy with 12-Step (CVT+12S), a manualized approach that provided the major acceptance-based strategies used in DBT in combination with participation in 12-Step programs. In addition to psychosocial treatment, subjects also received concurrent opiate agonist therapy with adequate doses of LAAM (thrice weekly; modal dose 90/90/130 mg). Treatment lasted for 12 months. Drug use outcomes were measured via thrice-weekly urinalyses and self-report. Three major findings emerged. First, results of urinalyses indicated that both treatment conditions were effective in reducing opiate use relative to baseline. At 16 months post-randomization (4 months post-treatment), all participants had a low proportion of opiate-positive urinalyses (27% in DBT; 33% in CVT+12S). With regard to between-condition differences, participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT+12S significantly increased opiate use during the last 4 months of treatment. Second, CVT+12S retained all 12 participants for the entire year of treatment, compared to a 64% retention rate in DBT. Third, at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT+12S.

Keywords: Dialectical behavior therapy, Borderline personality disorder, Heroin, Co-morbidity, Psychotherapy, Women