6.+Treatment

Treatment
 * __Borderline Personality Treatment __**

Borderline Personality Disorder, like all personality disorders is very difficult to treat. Dialectical Behavioural Therapy was developed by Marsha M. Linehan to treat people with BPD. It consists of 4 modes of treatment:

 1. Individual Therapy  2. Group Skills Traiing  3. Telephone Contact  4. Therapist Consultation Individual therapy is run based on a hierarchy of targets. The tops targets are issues that need to be dealt with immediately such as decreasing suicidal behaviour, decreasing therapy interfering behaviour, and decreasing behaviours that negatively affect one’s quality of life. Next, behaviours associated with self esteem and social situations are targeted. Finally, any issues the client feels are important are targeted.

Group skills training is a group therapy where 4 specific skills are taught. These skills are:  1. Mindfullness  2. Interpersonal Skills  3. <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Distress Tolerance Skills

Because people suffering from BPD have a lot of trouble identifying and understanding their emotions, it is vital to teach them the skills to do so as well as how to deal with these emotions Telephone contact is very important because people with BPD will often have thoughts of suicide. It is necessary for these clients to be able to reach a counsellor at all hours. Finally, therapist consultation is a unique aspect. It requires therapist to actually partake in dialectical behavioural therapy with their colleagues. This is to prevent burnout and to be bettr able to help the client.

**__Alcohol Abuse Treatment__** There are no easy solutions to alcohol abuse and alcoholism. Relapses often occur, which can be frustrating and discouraging. Becoming sober is especially difficult with lack of support systems and encouragement. Unless a person feels emotionally and physically ready to quit drinking it is often close to impossible. It is necessary for a person with an alcohol abuse problem have the drive and motivation to stop using.

The following resources are a good place to start when trying to seek help.


 * Trusted friends or family members-**Trusted friends or family might be a good sounding board for concerns about alcohol abuse. Alcohol could be affecting you more than you think and family and friends would be able to help in the realization of the problem.


 * Peer Support-**Peer support groups like Alcohol Anonymous (AA) provide a place to share experiences with alcohol abuse and others experiences in alcohol recovery. Alcohol Anonymous allows the opportunity to interact with others with similar problems; this can help in the realization that you are not alone.


 * Therapy-** A therapist can help the release of emotions that may be hard to express with friends or family. A therapist is beneficial for alcohol treatment because they are able to provide an unbiased nonjudgmental view of the situation


 * Medical Professional-** When dealing with alcohol addiction working towards a sober lifestyle may cause withdrawal symptoms that require medical intervention. A family doctor can be a good starting reference, and you may want to consider working with an addiction medicine specialist to help with a more in depth analysis.

There are a variety of different program options for people with substance abuse problems. The programs are generally dependant on the individual and what is most suited for them. <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Assessment and Case Management <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Individual Support <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Skills-based groups <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Controlled-use groups <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Abstinence-based groups These programs generally allow for an individual to take a few hours a week to reflect on their substance use problem. The majority of substance-related needs can be satisfied on an outpatient basis. In addition to this, programs can also vary depending on age. There are youth programs as well as adult programs, this helps to benefit the individual so they feel comfortable with the group they are involved with. Residential Withdrawal Management Services- ** Formerly known as “Detox”, Residential withdrawal management are most beneficial to those using drugs and alcohol that lack supportive environments and are not able to stop using on their own. <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Staff is trained to ensure a safe withdrawal process in a non-medical setting. Residential Withdrawal management provides a variety of counselling techniques, including motivational counselling. Highlights of Residential Withdrawal Management Services: <span style="color: black; font-family: Symbol; mso-ansi-language: EN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msoansilanguage: EN; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Support is available 24 hrs/day <span style="color: black; font-family: Symbol; mso-ansi-language: EN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msoansilanguage: EN; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Includes discharge planning and referrals <span style="color: black; font-family: Symbol; mso-ansi-language: EN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msoansilanguage: EN; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Motivational Counselling <span style="color: black; font-family: Symbol; mso-ansi-language: EN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msoansilanguage: EN; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">On-Site assessment and referrals ** Community Withdrawal Management Services- ** is an alternative to Residential Withdrawal management Services. This is for those with less severe withdrawal symptoms who have a supportive home life. This can be beneficial if the individual suffering with the substance abuse is unable to leave the home due to responsibilities. <span style="color: black; font-family: Calibri; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">Alcohol Anonymous meetings are generally available in most communities and attendance can be very important for people with alcohol abuse problems.
 * Community Treatment-** formerly known as ‘outpatient services’ Community Treatment Services include a variety of difference services, generally available one to two hours a week. A variety of treatment options include:


 * Refer to page 7 "Where to Seek Assistance & Best Practices" for agencies that can help with substance use*

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"><span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">The potential outcomes of mixing alcohol with prescribed medication for BPD can be very dangerous and often times fatal. Moreover, the improper use of alcohol or medication of any type is not recommended and can have serious negative consequences...

Treatment of Alcoholism <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;"> · <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Benzodiazepines: <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;"> Are anti-anxiety medications that work to inhibit nerve cell excitability in the brain. In terms of treatment for alcohol they are believed to relieve withdrawal symptoms, prevent progression to delirium tremens and reduce the risk of alcohol-related seizures (About.com, 2009). <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Some commonly reported side-effects of these medications are daytime drowsiness and feelings similar to a hangover, additionally they have been known to be very dangerous when used in combination with Alcohol as benzo’s are too depressants they may slow down the respiratory system or interacts with certain other medications such as oral contraceptives for example. Benzodiazipines are also associated with birth defects and should not be consumed by pregnant or nursing women (About.com, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Longer-lasting drugs like chlordiazepoxide (Libritabs, Librium), oxazepam (Serax), and halazepam (Paxipam) are preferred as they pose less risk for the possibility of abuse compared to shorter-acting medications such as diazepam (Valium), alaprazolam (Xanax), lorazepam (Ativan) (About.com, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Anti-seizure drugs like carbamazepine (Tegretol) or divalproex sodium (Depakote) may be useful in reducing the need to use benzo’s. They work better when given together because they have not been proven effective in reducing seizures or delirium associated with alcohol withdrawal (About.com, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Beta-blockers like propranolol (Inderal) and atenolol (Tenormin), are sometimes administered in combination with benzodiazepines. They have been shown to slow heart rate and may also be useful in the reduction of cravings (About.com, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">·  <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 9pt;">Antabuse (Disulfiram), & Acetaldehyde have been frequently prescribed in the past for the treatment of alcohol-abuse. Treatment of Borderline Personlity Disorder Treatment of BPD is much more evidence-based now than it once was. For instance, focus now-a-days is on psycho-education, using evidence-based psychotherapy, and medication. Some helpful versions of therapy include dialectical behavioural theory, schema-focused therapy, mentalization-based therapy and transference focused therapy (Americian Psychiatric Publishing, n.d.). More information on treatment this is available in a pdf document through the website: []

Many types of medications have been used in the treatment of Borderline Personality disorder along with treatment. For some medications the evidence base is fairly limited, so we will focus on some of the most commonly prescribed types. According to Wikipedia (2009) BPD has typically been considered to be a primarily psychosocial condition therefore when medication is used it is intended for the treatment of some of the co-morbid symptoms like anxiety, depression, and self-harm for instance. <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"><span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Antidepressants: <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">such as SSRI’s (Selective serotonin reuptake inhibitors), and antidepressants have proven to be effective in relieving some of the attendant symptomatology of anxiety and depression such as anger and hostility (Wikipedia, 2009). <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">According to one study, it takes a higher dose of an SSRI to treat mood disorders associated with BPD than depression alone. Additionally, it takes approximately 3 months or so for benefit to appear, versus the 3-6 weeks it takes on average for the depression medications to take effect (Wikipedia, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Antipsychotics: <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Some of the newer antipsychotic medications are thought to have an improved adverse effect profile than typical antipsychotics prescribed in the past, and they are generally only used short-term (Wikipedia, 2009). <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">These are frequently prescribed to treat some of the distortions in thinking or false perceptions associated with BPD (Wikipedia, 2009). <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Typical types include olanzapine, clozapine, quetiapine, and risperidone (which has been found effective in dealing with some of the psychotic-like or impulsive, suicidal symptoms (Wikipedia, 2009). <span style="font-family: 'Courier New'; font-size: 9pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o  <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Tardive dyskinesia has been known to occur as an unfortunate side effect of these medications. In addition atypical antipsychotic medications have been known to cause weight gain which is also associated with further health complications (Wikipedia, 2009). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">According to Ferrerri, Lize, Rouillon, & Limosin (2004). Clozapine works by acting antagonistly on D1, D2, D3, D4, & D5 receptors. It appears to have a strong affinity for the D1 & D4 receptors. It is a drug that works by blocking 5HT receptors. <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Additionally, olanzapline, and rispridone have also been prescribed to individuals in treating some symptoms related to BPD (Grootens, Verkes, 2005). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">SSRI’s can also be helpful in the treatment of some impulsive behaviours and comorbid affective disorders. Benzo’s, mood stabilizers and neuroleptics, anticonvulsants and lithium may also be recommended in dealing with aggressive or psychotic symptoms (Ferrerri et al., 2004; Oldham, Bender, Skodol, Dyck, Sanislow, Yen... & McGlashin, 2004). <span style="font-family: Symbol; font-size: 9pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Symptoms of impulsive-behavioural dyscontrol has been found to predict the use of neuroleptics and anticonvulsants in treatment. Cognative-perceptual symptoms were also found to be inversely related to anticonvulsant use (Oldham, Bender, Skodol, Dyck, Sanislow, Yen... & McGlashin, 2004).

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">References:

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 9pt; mso-ansi-language: EN-CA; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; msoansilanguage: EN-CA; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US; msofareastthemefont: minor-latin;">About.com. (2009). Specific medical treatment for alcohol withdrawal symptoms: Treatment depends on the severity of symptoms. Retrieved **online** October 18th, 2009, from []

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;">Belmonte, J. (2009). //Alcohol Treatment, Rehab and Detox. // Retrieved November 18, 2009 from [] <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt; line-height: 115%;"> <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"><span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt; line-height: 115%;">Ferrerri, M. M., Loze, J. Y., Rouillon, F., Limosin, F. (2004). Clozapine treatment of a borderline personality disorder with a severe self-mutilating behaviours. European Psychiatry 19, 177–178. doi:10.1016/j.eurpsy.2003.11.004 Grootens, K. P., Verkes, R. J. (2005). Emerging evidence for the use of atypical antipsychotics in Borderline Personality Disorder. Pharmapsychology MediResource Inc. (2009). 38(1), 20-23. Retrieved online October 18th, 2009, from Scholars Portal Online Database.

Kiehn, B., Swales, M. (1998). An overview of dialectical behavioural therapy in the treatment ofbordeline personality disorder. //<span style="font-family: 'Lucida Sans Unicode','sans-serif';">Psychiatry on-line. //Retrieved November 18, 2009 from []

<span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Oldham, J. M., Bender, D.S., Skodol A.E., Dyck, I.R., Sanislow, C.A., Yen, S., Grilo, C.M., Shea, M.T., Zanarini, M.C., Gunderson, J.G., & McGlashin, T.H. (2004). Testing an APA Practice Guideline: Symptom-targeted medication utilization for paitents with borderline personality disorder. Journal of Psychiatric Practice, 3(10), 156-161. Retrieved online October 20th, 2009, from Scholars Portal Database.

Pinewood Centre (2009). //Pinewood Centre of Lakeridge Health. //Retrieved November 18, 2009 from <span style="color: black; font-family: Arial,Helvetica,sans-serif; mso-ansi-language: EN; mso-bidi-font-family: Arial; msoansilanguage: EN; msobidifontfamily: Arial;">[] <span style="color: black; font-family: Arial,Helvetica,sans-serif; msoansilanguage: EN; msobidifontfamily: Arial;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;"> <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Wikipedia. (2009). Borderline Personality Disorder. Retrieved online October 18th, 2009 from []

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