Borderline Personality Disorder and Problems with Substance Use – May 1, 2009

Friday, May 1, 2009
8:00 a.m. @ 5:00 p.m.

Mary S. Harkness Auditorium, Sterling Hall of Medicine
333 Cedar Street, New Haven, CT 06520

Statement of Need

  • Diagnosis and treatment interventions of borderline personality disorder should begin as soon as possible
  • Borderline Personality disorder (BPD) is a severe and generally chronic disorder and people who suffer from it are underserved.
  • Friends and families are often bewildered and do not know how to help.
  • Treatment programs for those with BPD need to be more readily available.
  • Families need access to programs such as those already developed for several other mental illnesses.
  • BPD presents patients, their families, clinicians, and researchers with multiple challenges.
  • BPD frequently co-occurs with SUD, confounding all of the above challenges


The complex challenges associated with BPD and substance use will be addressed in order to inform mental health professionals, families and consumers of the most current diagnostic and treatment options available, and other issues of current interest to those affected by this disorder.


This conference will provide a forum for professionals, family members, and consumers to better understand the disorder from various perspectives.The Conference is for physicians, psychiatrists, psychologists, social workers, family therapists, counselors, nurses, emergency room personnel, law enforcement personnel and agencies, educators, family members, friends, and consumers. Mental health students are particularly encouraged to attend, and those registering are invited to a complementary lunch event.

Continuing Education Credits

This program has been approved for 7.0 Continuing Education Credit Hours by the National Association of Social Workers, CT and meets the continuing education criteria for CT Social Work Licensure renewal.(To receive a CE certificate at the end of the conference, license number and request for CE’s should be included in the registration information, or at time of sign-in / sign-out at the conference.)

Course Description

This conference is for mental health professionals, consumers, and family members. This conference will provide a forum for professionals, family members, and consumers to better understand the disorder from various perspectives. Presenters will offer current information on research and best practice relating to BPD and SUD, and family members and consumers will share their experiences. Each session allows time for questions and answers, and the day will close with an interactive panel discussion that will discuss issues of developing and disseminating BPD+SUD treatments.

Conference Objectives

This conference will provide a forum for professionals, family members, and consumers to better understand the disorder from various perspectives. Presentations will focus on:

  • Comorbidity: BPD and SUD
  • Associations of BPD with PTSD and SUD
  • Psychopharmacology and BPD and SUD
  • SUD therapies
  • DBT and substance use disorders
  • Dynamic deconstructive psychotherapy for BPD
  • Issues of developing and disseminating BPD+SUD treatments
  • Family and consumer experiences


Program for the Day

Welcome and Opening Remarks Seth R. Axelrod, PhD; Perry D. Hoffman, PhD; William Sledge, MD
BPD and Substance Use Disorders Comorbidity Samuel A. Ball, PhD
Seeking Safety for PTSD and SUD  Lisa M. Najavits, PhD
Psychopharmacology of BPD and SUD  Ismene Petrakis, PhD
 Family and Consumer Perspectives
DBT for BPD and Substance Use Disorders  M. Zachary Rosenthal, PhD
Dynamic Deconstructive Psychotherapy for BPD  Robert Gregory, MD


Course Directors

Seth R. Axelrod, PhD Assistant Professor of Psychiatry Yale University School of Medicine, DBT/DBT-SUD Intensive Outpatient Program Team Leader Yale-New Haven Psychiatric Hospital

Perry D. Hoffman, PhD President National Education Alliance for Borderline Personality Disorder

Conference Coordinators

Lisa Maccarelli, PhD Assistant Clinical Professor Department of Psychiatry, Yale University School of Medicine.

Jacquelyn N. Smith, LMSW Creedmore Psychiatric Center

Peggilee Wupperman, PhD Associate Research Scientist, Director Anger and Substance Treatment for Women, Yale University School of Medicine

Conference Registrar

Trish Woodward, MAT Secretary National Education Alliance for Borderline Personality Disorder

Faculty Presenters

Seth R. Axelrod, PhD Assistant Professor of Psychiatry, Yale University School of Medicine, DBT/DBT-SUD Intensive Outpatient Program Team Leader, Yale-New Haven Psychiatric Hospital

Samuel A. Ball, PhD Professor of Psychiatry, Yale University School of Medicine, Director of Research The APT Foundation

Kathleen M. Carroll, PhD Professor of Psychiatry, Yale University School of Medicine, Scientific Director, Center for Psychotherapy Development

Perry D. Hoffman, PhD President, National Education Alliance for Borderline Personality Disorder, (NEABPD)

Lisa M. Najavits, PhD Professor of Psychiatry, Boston University School of Medicine

Elizabeth Ralevski, PhD Research Scientist in Psychiatry, Yale University School of Medicine

M. Zachary Rosenthal, PhD Assistant Professor Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Director Cognitive Behavioral Research and Treatment Program, Director E.M.B. Brout Sensory Processing and Emotion Regulation Program

William H. Sledge, MD George D. and Esther S. Gross Professor Interim Chair, Department of Psychiatry, Yale University School of Medicine, Medical Director Yale-New Haven Psychiatric Hospital, Acting Chief of Psychiatry Yale-New Haven Hospital

Presentation Objectives

Samuel A. Ball, PhD
Professor of Psychiatry, Yale University School of Medicine
BPD and Substance Use Disorders Comorbidity

  1. Participants will learn about the high prevalence of borderline personality disorder (BPD) among substance use disorder patients and the high rates of SUD in patients diagnosed with BPD.
  2. Participants will gain familiarity with the central role of two broad personality (and psychopathology) dimensions related to negative affect (and internalizing disorders) and behavioral disinhibition (and externalizing disorders) in both BPD and SUD.
  3. Participants will learn about the prognostic significance of BPD-SUD co-occurrence with regard to symptom presentation, treatment response, and follow-up outcome.

Lisa M. Najavits, PhD
Professor of Psychiatry. Boston University School of Medicine
Seeking Safety for PTSD and SUD

  1. To review scientific literature on rates and presentation of PTSD/substance abuse;
  2. To increase empathy and understanding of PTSD/substance abuse;
  3. To describe specific therapeutic strategies for this dual diagnosis;
  4. To provide assessment and treatment resources.

Elizabeth Ralevski, PhD
Research Scientist in Psychiatry, Yale University School of Medicine
Psychopharmacology of BPD and SUD

  1. Review the pathophysiology of BPD and the pathophysiology of SUD
  2. Orient participants to current practice standards for treating BPD and for treating SUD
  3. Introduce potential medication strategies for treating comorbid BPD and SUD

Kathleen M. Carroll, PhD
Professor of Psychiatry, Yale University School of Medicine
What are empirically supported therapies for substance use disorders, where did we get them, and what do we do with them?

  1. Understand what empirically supported therapies are, as well as how they are developed and evaluated.
  2. Identify some empirically supported therapies for substance use disorders
  3. Recognize some of the challenges in transporting empirically validated therapies to clinical practice.

M. Zachary Rosenthal, PhD
DBT for BPD and Substance Use Disorders

  1. Understand basic principles underlying Linehan’s biosocial model of borderline personality disorder
  2. Learn the rationale for adapting DBT to address substance use disorders
  3. Identify how DBT has been modified to incorporate problems with substance use

Robert Gregory, MD
Associate Professor of Psychiatry, SUNY Upstate Medical University
Dynamic Deconstructive Psychotherapy for BPD and SUD

  1. Participants will learn the latest neurobiological research on the links between aberrant processing of emotional experiences and the development of hyperarousal, which is frequently managed by overuse of substances
  2. Participants will become familiar with principles and empirical research for dynamic deconstructive psychotherapy and how this treatment is hypothesized to dampen hyperarousal and restore functioning
  3. Participants will learn how to implement some key treatment techniques


Seth Axelrod, PhD is an assistant professor in the Department of Psychiatry at the Yale University School of Medicine and the team leader of the DBT and DBT for Substance Use Disorders (DBT-SUD) programs at the Yale-New Haven Hospital Intensive Outpatient Program. He received his PhD from the University of Kentucky, completed his internship focused on DBT with the Connecticut Department of Mental Health and Addiction, and obtained postdoctoral training in personality disorders in the Department of Psychiatry at the Yale University School of Medicine. He founded the Connecticut DBT Network, which promotes DBT referrals and communication among DBT providers to support DBT Treatment in the State of Connecticut. Dr. Axelrod teaches and supervises mental health trainees and professionals in DBT and personality disorders, and provides consultation to schools and mental health agencies. He developed the annual Yale conference on Borderline Personality Disorder, and he is actively involved in research focusing on borderline personality disorder and DBT adaptations.

Perry D. Hoffman, Ph.D. is the President and a co-founder of the National Education Alliance for Borderline Personality Disorder (NEABPD). She has several grants from the National Institute of Mental Health with a focus on families who have a relative with borderline personality disorder. Dr. Hoffman is co-designer of the 12-week psycho-education course for families, Family Connections, which is available in many locations both in the United States as well as other countries. She is a co editor, with John G. Gunderson, MD, of the book Understanding and Treating Borderline Personality Disorder: A Guide for Professionals and Family Member and co editor of Borderline Personality Disorder: Meeting the Challenges to Successful Treatment currently in press. Dr. Hoffman, who is intensively trained in Dialectical Behavior Therapy (DBT), has been the director of several treatment programs in the New York area and now is in private practice in New York City and Westchester County, NY.


Samuel A. Ball, Ph.D. is a Professor of Psychiatry at the Yale University School of Medicine and Director of Research for The APT Foundation in New Haven, CT. He also coordinates psychology training in the Division of Substance Abuse, supervises and teaches psychology interns, and mentors and coaches junior faculty at Yale and other universities. His research focuses on the assessment and treatment implications of personality dimensions, personality disorders, and multidimensional subtypes in substance abuse. Dr. Ball is the developer of Dual Focus Schema Therapy that has shown promising results in several clinical trials with substance abuse patients who have co-occurring personality disorders.

Dr. Kathleen M. Carroll graduated summa cum laude from Duke University, received her Ph.D. in clinical psychology in 1988 from the University of Minnesota, and completed her pre-doctoral training at the Yale University School of Medicine’s Division of Substance Abuse, where she was promoted to Professor in 2002. Since 1994 she has served as Scientific Director of the Center for Psychotherapy Development at Yale, NIDA’s only Center devoted to behavioral therapies research, and since 1999 she has been Principal Investigator of the New England Node of the National Institute on Drug Abuse’s Clinical Trials Network, one of the four founding centers funded in this national infrastructure. A Thompson Institute for Scientific Information Highly Cited Researcher, Dr. Carroll is the author of over 150 peer-reviewed publications as well as numerous chapters and books. Her research has focused on the development and evaluation of behavioral treatments and combinations of behavioral therapies and pharmacotherapies, with an emphasis on improving the quality and rigor of clinical efficacy research in the addictions. Dr. Carroll received a NIH MERIT (Method to Extend Research in Time) award in 2003 for her work on developing President of the American Psychological Association’s Division 50 (Addictions) from 2002-2005 and received the Divisions’ Distinguished Scientific Contributions to Education and Training Award in 2005.

Dr. Robert Gregory is Associate Professor in the Department of Psychiatry at SUNY Upstate Medical University, where he currently serves as Director of their Syracuse Center for Psychotherapy. His educational background encompasses a B.S. in biology at Cornell University, an M.D. at SUNY Buffalo School of Medicine, and residency training in psychiatry at Harvard’s Beth Israel Hospital. Dr. Gregory’s clinical and research interests include borderline personality disorder, addictions, suicide prevention, and psychodynamic psychotherapy. He has authored numerous publications and presentations elaborating theoretical models and empirical research of borderline personality disorder and has been the recipient of nine separate awards for his teaching of medical students and psychiatry residents. Dr. Gregory has developed a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy, which particularly targets those patients who have co-occurring substance use disorders. He has recently completed a 12-month randomized controlled trial of this treatment method for patients with co-occurring borderline personality disorder and alcohol use disorders, which was published in the March issue of Psychotherapy. The results support its effectiveness in reducing self-harm, suicide attempts, problematic drinking behavior, and inpatient utilization.

Lisa M. Najavits, PhD is Professor of Psychiatry, Boston University School of Medicine; Lecturer, Harvard Medical School; clinical psychologist at the National Center for PTSD, Veterans Affairs Boston Healthcare System; and psychologist at McLean Hospital. She is author of the books Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (2002) and A Woman’s Addiction Workbook (New Harbinger Press; 2002), as well as over 125 professional publications. In 1997 she was recipient of the Chaim Danieli Young Professional Award of the International Society for Traumatic Stress Studies; in 1998 the Early Career Award of the Society for Psychotherapy Research; and in 2004 the Emerging Leadership Award of the American Psychological Association’s Committee on Women. She is currently president-elect of the American Psychological Association Division on Addictions. She is past-president of the New England Society for Behavior Analysis and Therapy; and on the advisory boards of Psychotherapy Research, Psychology of Addictive Behaviors, and the Journal of Gambling Studies. Dr. Najavits has received a variety of National Institutes of Health research grants, including an independent scientist career award from the National Institute on Drug Abuse. She is a fellow of the American Psychological Association; board certified in behavioral therapy; a licensed psychologist in Massachusetts; a psychotherapy supervisor; and conducts a psychotherapy practice. She received her PhD in clinical psychology from Vanderbilt University (Nashville, Tennessee) and her bachelor’s degree with honors from Columbia University (New York, New York). Her major clinical and research interests include: trauma, posttraumatic stress disorder; substance abuse; and psychotherapy outcome research.

Elizabeth Ralevski, PhD is a Research Scientist at Yale University. She received her BA and completed her Ph.D. degree in Psychology at York University in Toronto, Canada in 1999. She finished her two-year post-doctoral training at McLean Hospital, Harvard Medical School in 2001. That same year she joined the faculty at Yale University.

Dr. Ralevski is pursuing research into various aspects of substance abuse, with a primary focused on alcoholism. Current research projects are focusing on treatment studies with novel psychopharmacological approaches to the treatment of individuals who are diagnosed with alcoholism and other psychiatric conditions including depression, post traumatic stress disorder, schizophrenia and borderline personality disorder. Her other research examines factors, such as stress, that may lead to the development and maintenance of alcoholism and other mental disorders.

M. Zachary Rosenthal, PhD is an Assistant Professor in the Duke University Medical Center Department of Psychiatry and Behavioral Sciences, and is Director of both the E.M.B. Brout Sensory Processing and Emotion Regulation Program and the Duke Cognitive Behavioral Research and Treatment Program (CBRTP). Dr. Rosenthal received his Ph.D. from University of Nevada, Reno, after completing an internship in medical psychology at Duke University Medical Center. Dr. Rosenthal’s line of research has focused on characterizing problems with emotional functioning and emotion regulation in borderline personality disorder (BPD). Recently, his research has expanded to the development of novel computer-based interventions for treatment-resistant populations. He is the PI on a NIDA-funded project (R01-018311) developing a virtual reality-based cue exposure platform and cellular phone-based extinction reminder delivery system to augment treatment for substance abusers. This work has recently been featured on ABC’s Good Morning America as an example of cutting edge research using new technologies. In addition, he is the PI on a NIDA-funded study (R01-017372) evaluating the efficacy of Dialectical Behavior Therapy (DBT) for opioid dependent adults with BPD. He has published in scientific journals and book chapters, including, Emotion, Journal of Abnormal Psychology, Clinical Psychology Review, Journal of Traumatic Stress, and Behavior Research and Therapy. Clinically, Dr. Rosenthal is a licensed clinical psychologist in North Carolina who is trained in cognitive behavioral therapy (CBT) and is an expert in the treatment of BPD and other difficult-to-treat populations using dialectical behavior therapy (DBT). Dr. Rosenthal provides clinical supervision to Duke University clinical psychology graduate students, medical psychology interns, Psychiatry residents, and post-doctoral fellows. In addition, Dr. Rosenthal provides educational trainings to community mental health and substance abuse professionals through a partnership between Duke University and the North Carolina Evidence-Based Practices Center.

William Sledge, MD, Interim Chair and George D and Esther S Gross Professor of Psychiatry and Lecturer in Humanities, is the Acting Psychiatrist in Chief of Yale New Haven Hospital and the Medical Director of the Yale New Haven Psychiatric Hospital. He is a graduate of the Western New England Institute for Psychoanalysis and has clinical interests in  schizophrenia, psychiatric problems of the aeromedical environment, and various forms of psychological treatment. He teaches a freshman seminar on an introduction to Freud and has taught a Yale College seminar on intimacy and the American family in the last half of the 20th Century for several years. His research interests include health services focusing on problems in the present health care system such as recidivism and high cost patients. He was born and raised in Greensboro, Alabama, graduated from Washington and Lee University, in Lexington, VA, with a major in English literature. He attended medical school at Baylor College of Medicine in Houston, Texas, was an intern at the Philadelphia General Hospital on the University of Pennsylvania service and completed his residency at Yale. He has held a variety of administrative positions in the Department of Psychiatry and from 1995 until 2005, he and his wife were Master and Associate Master of one of Yale’s residential college, Calhoun College. In 1995 he took the mastership of Calhoun College and served happily for ten years. During that time he was Chair of the Council of Masters for three years. Dr. Sledge serves on several professional and service boards, including Fellowship House in New Haven, and is a member of the Advisory Board of the Auburn Rural Studio.


Lisa Maccarelli, Ph.D. is a Psychologist and an Assistant Clinical Professor in the Yale University School of Medicine’s Department of Psychiatry with extensive experience in the treatment, consultation, and supervision of clients diagnosed with Borderline Personality Disorder and/or substance use disorders using Dialectical Behavior Therapy (DBT) and Dr. Jeffrey Young’s Schema Therapy. Her interests include psychotherapy outcome research for personality disorders, substance abuse, and depression, and she currently serves as the Project Director for a treatment outcome study funded by the National Institute on Drug Abuse (NIDA). In addition, Dr. Maccarelli provides psychotherapy supervision to psychology fellows and staff at community mental health centers in the New Haven area, and she conducts Dialectical Behavior Therapy for substance abuse clients through the APT Foundation.

Jacquelyn N. Smith, LMSW, came to NYC in 2003 to attend Columbia University School of Social Work. During her second-year year internship at Creedmoor Psychiatric Center she was exposed to and began practicing DBT with patients struggling with dysfunction related to Borderline Personality Disorder. She completed her internship under the auspices of Andre Ivanoff, Ph.D., professor at CUSSW and International Trainer and Consultant for Behavioral Tech, LLC, the agency overseeing the implementation of DBT. From this internship, she was Intensively Trained in DBT at the Bronx VA in 2005. After briefly working at F.E.G.S. upon graduation from CUSSW, she worked for 2 1/2 years at the NYPH/Payne Whitney day program performing individual and group psychotherapy, and half-time in the DBT track. Her professional life then became full circle as she returned to Creedmoor Psychiatric Center on the Dialectical Behavior Therapy ward where she first trained in DBT. ‘DBT is my passion,” she says, and working to create a life worth living for those struggling with dysfunction resulting from BPD. I am always seeking to learn more, expand my knowledge base, and become involved to bring hope to those seeking a better life in spite of BPD. I look forward to working with NEABPD in my ongoing quest to spread the word about the support available for individuals with BPD and their loved ones.

Peggilee Wupperman, PhD, is an Associate Research Scientist at Yale School of Medicine and the Director of the Anger and Substance Treatment at the Yale PSS Clinic. Dr. Wupperman has extensive experience in research and treatment of individuals with BPD features and emotion/behavioral dysregulation. She was trained in Dialectical Behavior Therapy while on internship at Yale School of Medicine, and she obtained additional DBT training through a postdoctoral fellowship with Marsha Linehan at the University of Washington. Dr. Wupperman is currently developing and evaluating a treatment for women who have problems with aggression and substance abuse (Mindfulness Therapy for Self-Regulation; MTS). She is also working to further her research that suggests mindfulness deficits predict BPD features and related behavioral dysregulation. In addition, Dr. Wupperman provides training, consultation, and supervision for DBT clinicians and consultation groups throughout Yale School of Medicine. She also has the privilege of providing therapy to clients with BPD and BPD features.