Treatment of Co-Morbid Methamphetamine Substance Abuse and Borderline Personality Disorder PDF
Preview Treatment of Co-Morbid Methamphetamine Substance Abuse and Borderline Personality Disorder
Western Michigan University ScholarWorks at WMU Dissertations Graduate College 12-2007 Treatment of Co-Morbid Methamphetamine Substance Abuse and Borderline Personality Disorder Features Using Modifed Dialectical Behavior Terapy Jessica R. Schultz Fischer Western Michigan University Follow this and additional works at: htps://scholarworks.wmich.edu/dissertations Part of the Clinical Psychology Commons, and the Substance Abuse and Addiction Commons Recommended Citation Schultz Fischer, Jessica R., "Treatment of Co-Morbid Methamphetamine Substance Abuse and Borderline Personality Disorder Features Using Modifed Dialectical Behavior Terapy" (2007). Dissertations. 859. htps://scholarworks.wmich.edu/dissertations/859 Tis Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact TREATMENT OF CO-MORBID METHAMPHETAMINE SUBSTANCE ABUSE AND BORDERLINE PERSONALITY DISORDER FEATURES USING MODIFIED DIALECTICAL BEHAVIOR THERAPY by Jessica R. Schultz Fischer A Dissertation Submitted to the Faculty o f The Graduate College in partial fulfillment o f the requirements for the Degree o f Doctor o f Philosophy Department o f Psychology Dr. Amy E. Naugle, Advisor Western Michigan University Kalamazoo, Michigan December 2007 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TREATMENT OF CO-MORBID METHAMPHETAMINE SUBSTANCE ABUSE AND BORDERLINE PERSONALITY DISORDER FEATURES USING MODIFIED DIALECTICAL BEHAVIOR THERAPY Jessica R. Schultz Fischer, Ph.D. Western Michigan University, 2007 The study investigated the effectiveness of a time-limited, skills-based treatment in a population of female substance abusers. This project implemented a pilot clinical trial to evaluate the effectiveness of a 12-session modified Dialectical Behavior Therapy (DBT) protocol among a small sample of women, with co-morbid borderline personality disorder features, receiving concurrent outpatient treatment for methamphetamine abuse. A non-concurrent multiple baseline design was used. In addition to on-going assessment conducted during baseline and weekly over the course of treatment, a comprehensive assessment battery was administered pre-, and post-treatment as well as at 1 and 3 months following treatment. Findings suggest that notable improvements were made in several variables of interest among treatment completers and some non-completers. This study suggests that an abbreviated version of DBT, adapted to substance use and dependence issues, can be modestly effective for females with BPD features and MA dependence who demonstrate persistent attempts for change and mild to moderate symptoms of psychopathology. Clinical and research implications for DBT and substance use problems are discussed. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 3293167 INFORMATION TO USERS The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. ® UMI UMI Microform 3293167 Copyright 2008 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Copyright by Jessica R. Schultz Fischer 2007 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGMENTS This project was an ever-changing adventure and ensuing journey. The endeavor quickly became a labor of love, for which I owe many thanks to those who played key roles along the path. I would like to begin by acknowledging the influence and guidance of my advisor Amy Naugle. Your direction, thoughtfulness and never-ending efforts into this project were instrumental and much appreciated. Thank you to each member of my dissertation committee for your suggestions and efforts, especially Scott Gaynor for your willingness and encouragement to look at the data in new perspectives. For several essential components of this project and unwavering encouragement, thank you to David Fatzinger and the staff from Van Buren District Health Department. Also, to Robin Carter-Visscher, I will always have immense appreciation for the input, feedback and efforts you so graciously offered during the course of this project. Additionally, thank you to all the trauma lab members, graduate students and research assistants for all of their aid and support with the tedious but essential logistics and details of this project. I would also like to express a massive thank you to my husband Joe, in addition to family and friends, for their ongoing encouragement despite my long hours attached to the computer. I am truly grateful for your patience. Most importantly, I want to expresses my heartfelt thanks to the participants - through your willingness, resilience, courage and resolve you have taught me more than you will ever know. I am humbled and indebted. Jessica R. Schultz Fischer ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS ACKNOWLEDGMENTS............................................................ ii LIST OF TABLES ........................................................................................... v LIST OF FIGURES.................................................................................................... vii CHAPTER I. LITERATURE REVIEW............................................................................. 1 Methamphetamine Use and Abuse........................................................ 1 Conceptualization of Substance Abuse and Dependence.................... 5 Dialectical Behavior Therapy................................................................ 7 Applications of DBT to Substance Abuse and Dependence............... 12 Conceptualization................................................................................... 15 II. METHODS.................................................................................................... 18 Participants............................................................................................. 18 Experimental Design.............................................................................. 19 Procedures.............................................................................................. 21 III. RESULTS...................................................................................................... 36 Participant Results.................................................................................. 37 Hypotheses............................................................................................. 58 Additional Treatment Goals.................................................................. 86 Follow Up and Maintenance of Treatment Effects.............................. 93 Participant Satisfaction........................................................................... 95 iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents - Continued CHAPTER IV. DISCUSSION................................................................................................ 96 Overall Findings..................................................................................... 96 Considerations and Limitations............................................................. 101 Summation and Future Research........................................................... 104 REFERENCES........................................................................................................... 106 APPENDICES............................................................................................................ 113 A. Oral Recruitment Script................................................................................ 113 B. Recruitment Flyer.......................................................................................... 115 C. Participant Informed Consent....................................................................... 117 D. Release of Information Form........................................................................ 122 E. Assessment Materials.................................................................................... 124 F. Diary Card...................................................................................................... 139 G. Therapist Adherence Form........................................................................... 142 H. Client Satisfaction Questionnaire................................................................. 147 I. Treatment Manual.......................................................................................... 149 J. Research Protocol Approval......................................................................... 163 iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES 1. COPE Subscale Correlation Matrix Select..................................................... 25 2. Therapist Adherence Ratings per Rated Item................................................ 34 3. T-test Comparisons of Completers vs. Non-Completers: Pre-Treatment Assessment................................................................................ 59 4. Global Severity Index for Brief Symptom Inventory for Participants at Pre-Treatment, Last Treatment Session, Follow-Up, 1-Month and 3-Month....................................................................................................... 63 5. Positive Coping Skills from COPE Measure for Participants at Pre-Treatment, Last Treatment Session, Follow-Up, 1-Month and 3-Month.............................................................................................................. 67 6. Restraint Coping Skills from COPE Measure for Participants at Pre-Treatment, Last Treatment Session, Follow-Up, 1-Month and 3-Month.............................................................................................................. 68 7. Diary Card Skills Used Last Week of Treatment - Percent of Skills Actually Used out of Daily Opportunities to Use Skills................................. 69 8. Negative Coping Skills from COPE Measure for Participants at Pre-Treatment, Last Treatment Session, Follow-Up, 1-Month and 3-Month.............................................................................................................. 75 9. Emotion Regulation Questionnaire Scores for Treatment Completing Participants at Pre-Treatment, Follow-Up, 1-Month and 3-Month............... 76 10. Kentucky Inventory of Mindfulness Scale Scores for Treatment Completing Participants at Pre-Treatment, Follow-Up, 1-Month and 3-Month....................................................................................................... 77 11. Substance Use Coping Skills from COPE Measure for Participants at Pre-Treatment, Last Treatment Session, Follow-Up, 1-Month and 3-Month.............................................................................................................. 82 12. Drug Use Questionnaire Scores for Treatment Completing Participants at Pre-Treatment, Follow-Up, 1-Month and 3-Month.................................... 84 13. Additional Treatment Goals for Completers: Pre-Treatment, Follow-Up, 1 and 3-Month............................................................................... 88 v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. List of Tables - Continued 14. T-test Comparisons of Completers at Pre-Treatment and Posttreatment Assessments............................................................................... 90 15. T-test Comparisons of Treatment Non-Completers at Pre-Treatment and Last Repeated Assessments....................................................................... 92 16. T-test Comparisons of Slope at Pre-Treatment and Treatment for all Participants......................................................................................................... 93 vi Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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