DIALECTICAL BEHAVIOR THERAPY SKILLS TRAINING A THERAPEUTIC ALTERNATIVE IS DIALECTICAL BEHAVIOR THERAPY SKILLS TRAINING A THERAPEUTIC ALTERNATIVE IN ALCOHOL USE DISORDER AND PERSONALITY DISORDERS COMORBIDITY TREATMENT? Marco Cavicchioli (1-2), Mariagrazia Movalli (1-2), Pietro Ramella (1-2), Cesare Maffei (1-2) University Vita-Salute San Raffaele, Milan Department of Clinical Psychology, San Raffaele Hospital, Milan

PDs in SUDs the problem of pds in suds high co-occurrence, especially cluster B PDs (e.g. Grant et al., 2016) PDs showed high relapse rate during SUDs treatments (e.g. Bradizza et al., 2006) PDs were associated to increased drop-out from SUDs treatment (e.g. Brorson et al., 2013)

standard DBT DBT-ST as stand-alone treatment a possible solution standard DBT and DBT-ST as stand-alone treatment effective treatment for BPD-SUDs (e.g. Linehan et al., 1999, 2002) feasible interventions in clinical populations characterized by emotional dysregulation (e.g. Valentine et al., 2015) promising results in treating AUD (Maffei et al., under revision)

DBT-ST AS STAND-ALONE TREATMENT THERE ARE NO STUDIES IN LITERATURE THAT EXPLORE POSSIBLE BENEFITS IN USING DBT-ST AS STAND-ALONE TREATMENT FOR COMORBIDITY BETWEEN AUD AND PDs

between abstinence maintenance and emotional dysregulation change aims of the study This study aims to: compare primary (i.e. attrition rate, abstinence maintenance, alcohol addiction severity) and secondary (i.e. emotional dysregulation) treatment outcomes during 3-month DBT-ST program in AUD patients with and without PDs evaluate the relationship between abstinence maintenance and emotional dysregulation change among both subgroups

characteristics of intervention sample and characteristics of intervention 216 AUD subjects consecutively admitted to DBT-ST program. 62.5 % met criteria for at least one PDs PD-NOS (24.5%), NPD (15.3%), BPD (8.8%) NPD and BPD traits were most recurrent 206 patients concluded the intensive phase (1 month; 5 times a week). 10 (4.6%) dropped out. 170 patients (78.7%) concluded the post-intensive phase (2 months; twice a week). 46 (21.3%) dropped out. During the program, there were random weekly toxicological screenings. 216 subjects analyzed (ITT analysis: LOCF). intensive phase 4 weeks post-intensive phase 8 weeks 1 2 3 4 5 6 7 8 9 10 11 12 216 206 170 10 36

Fisher’s exact test: χ2(1) = .18, ns; ODD ratio = 1.16 results: attrition rate Fisher’s exact test: χ2(1) = .18, ns; ODD ratio = 1.16

Fisher’s exact test: χ2(1) = .72, ns; ODD ratio= 1.28 results: abstinence maintenance 72.1% reached abstinence the mean of consecutive days of abstinence reached during the program was 82.98 (45.03) 14.3% lapsed during the intensive phase 13.6% lapsed during the post-intensive phase Fisher’s exact test: χ2(1) = .72, ns; ODD ratio= 1.28 t (214) = 1.36, ns; d (95% CI) = -.19 (-.47 - .08)

alcohol addiction severity results: alcohol addiction severity Note: controlling for baseline levels, we did not reveal significant changes during the treatment [F (1,214) = 1.20, ns; pη 2 = .006]

Note: controlling for baseline levels, results: emotional dysregulation d (95% CI)= .62 (.33 - .90) d (95% CI) = .53 (.25 - .81) Note: controlling for baseline levels, we observed a significant main effects of time [F (1,214) = 4.22, p < .001; pη2 = .18] and group [F (1,214) = 4.58, p < .05; pη2 = .02], as well as a significant interaction effect time x group [F (1,214) = 4.58, p < .05; pη2 = .02]

results: lapse and emotional dysregulation

discussion overall, we observed a low attrition rate if DBT-ST is compared to other SUDs treatment (Aharonovich et al., 2008; Deane et al., 2012; Santonja-Gòmez et al., 2010) AUD with and without PDs co-diagnoses showed same drop-out rate DBT dialectical and attachment strategies enhance motivation, especially in PDs patients with SUDs (Bornovalova et al., 2007) up to 70% of participants reached abstinence and there were no differences between AUD with and without PDs in abstinence maintenance we revealed a large improvement in emotional dysregulation, which was related to abstinence maintenance (Maffei et al., under revision) nevertheless, PDs patients showed higher levels of emotional dysregulation during the treatment and the relationship previously mentioned was specific for this subgroup Emotional dysregulation remains the core vulnerability factor to relapse among PDs with SUDs.

limitations and future directions absence of a control condition our conclusions were based on post-hoc considerations no follow-up evaluations DBT-ST should be implemented with individual sessions in order to effectively reduce vulnerability factor to relapse among patients with PDs-SUDs.

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