Randomized Trial of Dual-Focused versus Single-Focused Individual Therapy for Personality Disorders and Substance Dependence

We conducted a randomized comparison of Dual Focus Schema Therapy with Individual Drug Counseling as enhancements to residential treatment for 105 substance dependent patients with versus without specific personality disorders. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using Cox Proportional Hazards, we found no psychotherapy differences in retention (days in treatment). Hierarchical Linear Modeling indicated that personality disordered participants started with higher psychiatric, interpersonal, and dysphoria symptoms, and both therapies reduced symptoms over 6 months. Contrary to predictions, Individual Drug Counseling resulted in more sustained reductions than Dual Focus Schema Therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms.