Clinicians developing treatment plans for clients with co-occurring personality disorders and addiction is complicated. For a start, dealing with these clients takes more time, as Sandra Valente, PhD, LADC, LPC, CCS, Naugatuck Valley Community College, Conn., told attendees at the National Conference on Addictive Disorders in St. Louis today.
Time is a problem on two fronts. One is getting reimbursed for extra time by managed care. Another is that the intake process often doesn't take enough time to evaluate clients. "Clients often come into the office with a diagnosis. But the diagnosis is not always accurate," she cautions. It is absolutely essential to do a proper assessment as "diagnosis drives treatment," Valente emphasizes.
Differentiating between symptoms associated with addiction versus underlying personality disorders may be a challenge, but "as clinicians, we must evaluate clients at the point in time that they come to us and we must eliminate alternative causes through clinical interview and standardized assessments."
"Our job is not to look at the symptoms, but to review specific criteria before making a diagnosis," she says. Not adhering to the required number of criteria is a major--and common--mistake clinicians often make. She cautions, "Has the client met the specific criteria as well as and the number of criteria?"
Valente reviewed the changes affecting the diagnosis and treatment of co-occurring personality disorders in the recent edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5 offers a number of advantages as a diagnostic tool, among which are the diagnosis and categorization of personality disorders. Another important update is that DSM-5 provides for changes in clients' status over time.
Because often they do.