Client Background, Problem, and Context
The client showed symptoms of self-instability that were reflected by unstable emotion and loss of identity recognition. Besides, clients with the same characteristics were reported to be extremely sensitive, confirming that they had a borderline personality disorder. Some clients describe the situation as having a disclosed nerve ending since small issues can cause excessive reactions. Thus, it is easy to understand how borderline personality disorder causes instability in relationships and reckless behavior. Such people find it difficult to think straight when confronted with overwhelming emotions.
In most cases, borderline personality disorder causes patients to act inappropriately, leaving them ashamed of their actions. It seems to be a distressing cycle that the client felt unlikely to cure. However, that is not the case. Effective medicine-assisted treatment and coping techniques are suitable for patients diagnosed with borderline personality disorder to help them gain control of their thoughts and actions. However, medical reports show that BPD has high comorbidity with substance use disorder (Kulacaoglu and Kose, 2018). Thus, the key area of our concerns is how medicine-assisted treatment reduces the use of opioids among women aged 25-50 diagnosed with BPD.
Evidence-based Practice Question
A borderline personality disorder is treatable. However, clients have to ensure that they seek a specialized approach. It is thus clear that most patients diagnosed with BPD get better but only after seeking the right treatments and support. Treatment is mainly linked to psychotherapy, while in some instances, medication may be prescribed. Psychotherapy helps regain the client’s ability to function, manage emotions, and lower impulsiveness in patients. Even though there are no drugs approved to treat borderline personality disorder, there are various medications that can help in co-occurring issues like anxiety and depression. This medication may entail antidepressants and mood-stabilizing drugs.
With that regard, the paper seeks to answer the following question. “Does Dialectical Behavior Therapy reduce opioid use in women aged 25-50 diagnosed with borderline personality disorder compared to cognitive behavioral therapy?”
Significance of the Problem
The medically assisted treatment uses a combination of counseling and behavioral therapies to provide a treatment approach to substance use disorders. These are clinically approved programs and are tailored towards addressing patients’ demands. A report by Wingenfeld et al. showed that in 2018 almost 2 million individuals had an opioid use disorder which entails prescription pain medication containing opiates (2018). Besides, most women have borderline personality disorders with has high comorbidity with other disorders like SUDs. The only way to opioids among women is through medical treatment compared to men. And women are at risk for pain and are highly sensitive to aspects of medication, resulting in an addiction to substances that target mu-opioid receptors. Hence most women diagnosed with BPD are at the risk of abusing opioids when prescribed to them. In most circumstances, behaviors like self-injury, hostile behavior, and food restriction are perceived as suicidal attempts to set the body to endurance mode to prepare the last reserves of the endogenous opioid system. Thus, assessing how psychotherapy lowers opioid use among women with BPD is vital for future clinical research and medical intervention for such patients.
Literature Review
Even though psychotherapy is regarded as the treatment of choice for patients diagnosed with personality, there are still no consent about the optimal level of care for such patients. Antonsen et al., (2014) conducted a study to assess the difference between step-down and outpatients therapy treatment for patients with BPD. The research applied a six years follow-u of the Ulleval personality project (UPP) which is a randomized clinical test differentiating between step-down and outpatient therapy treatment for patient with borderline BPD. It combined both group and individual therapy for long and short-term treatment. The research incorporated 115 women patients with borderline personality disorder. Evaluation of study took a duration of 9 months, 20 months, 5 years and 8 years in regard to a wide range of clinical standard like psychosocial performance, axis I and II diagnoses, interpersonal issues, and symptom extremity.
The study outcome showed that there were significant difference between the medication groups. Women in the outpatient group recorded a decline in psychosocial performance during the six years period of follow-ups, while patients in step-down treatment therapy marked a continuous enhancement in psychosocial performance. These results demonstrates that both healthcare-based long-term outpatient and step-down therapy for individual is significant in enhancing psychosocial performance in women with BPD (Antonsen et al., 2014). However, step-down proved to be more effective in post-medication stage showing that the approach stimulates long-term changes during the medication period.
Harned et al. (2018) assessed whether incorporating post-traumatic stress disorder medication into evidence-based practice would enhance psychosocial performance of women with BPD. The research evaluated 30 women with BPD, post-traumatic stress disorder, and self-injurious acts. These women randomized to get a one year dialectical behavior therapy with DBT protocol for PTSD. The study evaluated five performance domain for an interval of six months medication and at four months post medication. The outcome of the study showed that DBT along with DBT protocol was more significant compared to DBT in enhancing social adjustment, accomplishing quality global performance, and health-linked quality of life. The study applied time-lagged mixed effect framework showed that in each treatment there was a reduction in PSTD extremity and predicted enhanced social adjustment, health-liked quality of life. On the other hand, reduction in post-traumatic cognitions anticipated improvement in all performance with social adjustment excluded. The outcome offers an evidence that supports the role of change in traumatic-liked cognition as an active approach in enhancing performance result among women with BPD.
Kulacaoglu, and Kose (2018) analyzed borderline personality disorder in regard to vulnerability, and Awe. According to Kulacaoglu, and Kose (2018) borderline personality disorder is characterized by impulsivity, unstable interpersonal relationship, and self-image. The research analyzed several articles to determine a wide range of situation. The report indicated that patients with BPD record high rate of mortality especially women with substance abuse problem compared with other disorders. Even though there are studies on borderline personality disorder, the illness still have insufficient details. Kulacaoglu, and Kose (2018) reviewed recent articles in regard to etiology and treatment methods to BPD. This study concludes that BPD is linked with more clinical measures than other personality disorders and reports higher rate of suicidality. The etiology of the disorder is still not confirmed and the disorder is caused by genetic elements and childhood trauma. According to this research future articles should consider on determining factors that leads to development of BPD. Determining these factors will assist clinicians to reach a perfect treatment for BPD and substance use like opioid. The study concluded that psychotropic treatment are effective for the disorder particularly impulsive aggression. However, polypharmacy practice is not evidence-based and not considered in management of patients with BPD.
DeCou, Comtois, and Landes (2019) conducted a study to determine if Dialectical behavior therapy is signaificant for mediation of BPD and Opioid. The research synthesizes outcomes from clinical trials that evaluated self-directed violence and suicidality like suicide attempts and ideation. DeCou, Comtois, and Landes (2019) selected 20 participants for DBT trial. A random effects meta-analyses showed that DBT minimizes self-directed violence, and reduced frequency of suicidality. However, the study failed to show a significant pooled effect of DBT concerning suicidal ideation. The research concluded that DBT is effective treatment for lowering self-directed violence and accessing psychiatric crisis services. It thus, support DBT as first-line medication for prevention suicidal behavior and psychiatric emergency care in diverse clinical population.
Haktanir and Callender, (2020) studied meta-analysis of DBT for treatment for treating substance use. The research aggregated the outcome of the article at the post-treatment and follow-up examination. The outcome of the research showed that DBT group was more significant in substance use abstinence. In conclusion DBT is an effective treatment of substance-related issues.
Analysis and Applicability of the Evidence
Although the presumption that patients with a severe borderline personality disorder might experience significant long-term medication, there has been little research of psychotherapies taking more than two years for women with BPD. Some researchers have demonstrated that BPD medication has a significant improvement after two years, few researchers have examined the long-term course of the symptom after treatment. The above articles demonstrates that DBT is significant in treating substance use among patients diagnosed. The findings from these articles are credible since the sample size used is enough to make conclusion that DBT is effective for treating opioid use among BPD patients. The present research has a randomized design and intensive follow-up therapies for BPD patients. Presently, DBT and CBT are applicable in clinical settings; hence there is a need for a comprehensive comparison between treatments at various levels of care. Besides, these articles presents credible evidence since assessments were carried out in an ordinary healthcare facility. Women with BPD and comorbidity of opioid use were involved in these studies.
Clinicians might assume that for patients with BPD, systematic therapy would significantly contribute to personality functioning and improve resistance to substance use in the future. But some research has shown a considerable difference in the clinical course of women with BPD (Antonsen et al., 2014). Thus, more clinical studies are needed to evaluate how medication at a different level of care might affect the long-term course of opioid use among women.
Conclusion
Opioid use among women with BPD is a common problem. Thus, clinicians need to conduct comprehensive research on how medication reduces comorbidity between opioid use and borderline personality disorder. Although the paper failed to include symptoms associated with opioid use, DBT showed a continued improvement in substance use treatment among women with BPD. There is a considerable difference in the evidence used to answer the evidence-based questions. Future studies should improve understanding of how DBT treatment influences the long-term course of patients and assess if these treatment modes only work best for women compared to other patients.
References
Antonsen, B. T., Klungsøyr, O., Kamps, A., Hummelen, B., Johansen, M. S., Pedersen, G., … & Wilberg, T. (2014). Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC psychiatry, 14(1), 1-12.
DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior therapy, 50(1), 60-72.
Haktanir, A., & Callender, K. A. (2020). Meta-analysis of dialectical behavior therapy (DBT) for treating substance use. Research on Education and Psychology, 4(Special Issue), 74-87.
Harned, M. S., Wilks, C. R., Schmidt, S. C., & Coyle, T. N. (2018). Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions. Behavior research and therapy, 103, 53-61.
Kulacaoglu, F., & Kose, S. (2018). Borderline personality disorder (BPD): In the midst of vulnerability, chaos, and awe. Brain Sciences, 8(11), 201.
Wingenfeld, K., Duesenberg, M., Fleischer, J., Roepke, S., Dziobek, I., Otte, C., & Wolf, O. T. (2018). Psychosocial stress differentially affects emotional empathy in women with borderline personality disorder and healthy controls. Acta Psychiatrica Scandinavica, 137(3), 206-215.
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