Borderline personality disorder and persistently elevated levels of risk in 36 month outcomes for the treatment of heroin dependence

Aims. To determine the effects of borderline personality disorder (BPD) on 36-month outcomes for the treatment of heroin dependence. Design. Longitudinal cohort study. Setting. Sydney, Australia. Participants. A total of 429 heroin users enrolled in the Australian Treatment Outcome Study, interviewed at 36-month follow-up. Findings. The BPD group enrolled in significantly more different treatment episodes across follow-up, but there was no difference in the cumulative number of treatment days received. At 36 months, there were no group differences in sustained or current heroin abstinence, daily heroin use or level of polydrug use. BPD patients maintained significantly higher levels of crime, injection-related health problems, heroin overdose, major depression and poorer global mental health. In contrast to 12-month follow-up, at 36 months there were no group differences in the proportions who attempted suicide over the preceding 12 months or had recently borrowed used injection equipment. Conclusions. The clinical picture provided some cause for optimism since 12-month follow-up. Despite this, BPD patients maintained elevated risk levels across a number of domains. The fact that these risks were maintained indicates that this is a group that requires specific clinical attention for BPD-related risks.