1. 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

2. 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)

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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 (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 ( )

9. 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]

10. Note: controlling for baseline levels,
results:
emotional dysregulation
d (95% CI)= .62 ( )
d (95% CI) = .53 ( )
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]

11. results:
lapse and emotional dysregulation

12. 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.

13. 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.

14. THANK YOU FOR YOUR ATTENTION!
Any questions?