Borderline Personality Disorder (BPD) is a condition that can cause significant distress and increased risk of death. Many persons with BPD also have an alcohol use disorder (AUD) and there is evidence that this can worsen the outcome and course of both disorders.

Psychodynamic therapy (PT) involves one-to-one interactions with a therapist. It aims to promote the development of a coherent identity through addressing unconscious conflicts that underlie BPD and enhancing reflective capacity. PT has been shown to be helpful for BPD, but has not been tested for people who have BPD with co-occurring substance use disorders.

The proposed study is a one-year randomized controlled trial of PT for persons with BPD and co-occurring AUD. This will generate some initial data that can be used to determine the need and feasibility a larger and more definitive outcome study. Subjects who enroll are randomized to either a study group receiving weekly PT or to a control group receiving usual care. There is a target enrollment of 15 subjects in each group and a 12 month duration. Outcome measures are administered by a research assistant at enrollment, and then at 3-month intervals.

The investigators anticipate that the PT group will show trends towards better retention in treatment and greater improvement in self-harm, alcohol use, depression, dissociation, and relationships. If so, this would have important and positive implications for the large group of patients who suffer from BPD and co-occurring AUD.

Accepts Healthy Volunteers

Inclusion Criteria:

• Age between 18 and 45 years
• Meets diagnostic criteria for borderline personality disorder and for active alcohol abuse or dependence
• At least average intelligence

Exclusion Criteria:

• Meets diagnostic criteria for antisocial personality disorder, schizophrenia, or schizoaffective disorder