Rates of borderline personality disorder (BPD) among individuals with substance use disorder (SUD) are estimated to be as high as 65%. Such elevated rates present considerable challenges for drug treatment services given that individuals with co-occurring SUD and BPD have higher rates of relapse, treatment noncompliance, and poorer outcomes than those with either diagnosis alone. A systematic review investigating current treatment options for co-occurring SUD and BPD was conducted using Medline and PsycINFO. Randomized controlled trials were the focus. Six studies were included that examined the use of three psychosocial therapies: dialectical behavior therapy, dual focused schema therapy and dynamic deconstructive psychotherapy. Despite all studies demonstrating some treatment gains over time, there is currently insufficient evidence to recommend one treatment over another. Further research is needed to examine effective treatment options for co-occurring SUD and BPD, especially those that are likely to be applicable in mainstream drug treatment settings.