The primary aim of this paper is to describe key modifications made to standard Dialectical Behavior Therapy (DBT) for use with substance-dependent individuals with borderline personality disorder (BPD). Key modifications include application of dialectics to issues surrounding abstinence, a new set of substance abuse behavioral targets, a set of attachment strategies for difficult-to-engage and easily lost clients, and modification of some skills geared for substance abusing clients. Treatment outcome findings from a small 12-month uncontrolled pilot trial of DBT for methamphetamine-dependent women with BPD are presented. Of the 3 participants who commenced treatment, 2 completed treatment and were abstinent from use of all illicit drugs by 6 months; results were maintained for the duration of the assessment period 6 months later. These encouraging results suggest that DBT may hold promise for treating methamphetamine dependence.