We review the theory, techniques, and development of a manual-guided individual psychotherapy for substance-dependent individuals diagnosed with personality disorders. Dual Focus Schema Therapy (DFST) integrates relapse prevention for substance dependence with targeted work on early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. The first 3 patients (one each from DSM-IV Axis-II Cluster A, B, and C) treated during the pilot testing phase of the manual are summarized to illustrate differences in psychopathology, personality and interpersonal functioning, early maladaptive schemas and coping styles, and treatment response.