One of the most important skills to develop as a counselor is understanding and applying the correct DSM-5 Criteria, and working with a diverse team. As substance abuse professionals, we are generally included in the broader disciplines of “Mental” and “Behavioral Health,” in which we practice alongside numerous qualified professionals from those disciplines. Having a diverse treatment team is something that’s gotten increased attention over the past twenty years or so, and that’a a very good thing.

Not that long ago, the way mental health and addiction were treated was one at a time. Mental Health practitioners would usually say the substance abuse needed to be referred out and addressed first. Substance abuse pro’s would say the same thing about the emotional and psychological issues: they had to be treated before the drug and alcohol use could be addressed. The client would end up bouncing back and forth between the two, with predictably bad results.

When I entered the field in 2006, that was already beginning to change. Best Practices began to align with integrated treatment, in which substance abuse and mental health disorders are diagnosed and treated at the same time. This takes an extraordinary amount or patience, focus, and knowledge from the entire treatment team. Intoxication can look exactly like anxiety, depression and even Personality Disorders such as Borderline and Anti-social Personality Disorders, two of the most common in substance abuse.

On the other side of the issue is the presence of withdrawal symptoms, both acute and post-acute, that can be mistakenly diagnosed as a mental health condition. Withdrawal from stimulants is usually the opposite of the intoxication effects. These can include increased appetite, fatigue, insomnia or hypersomnia and psychomotor retardation or agitation. I’ve seen countless patients mis-diagnosed with depression, anxiety and even Personality Disorders because of the intensity of the symptoms. Sadly, I’ve come across an equally countless number of clinicians who are unable to identify those basic withdrawal symptoms, but continue to diagnose, assess, and treatment plan based on experience and “common sense.”

In later posts, I’ll address co-occurring disorders and their prevalence. It is certainly a fact that a very high percentage of substance abuse patients have co-occurring disorders. But that doesn’t mean that ALL such patients have them. Best Practices seem to state that co-occurring disorders such as anxiety, depression and even PTSD should be assumed. I agree, to a point. What’s equally important is that those assumptions are confirmed or dismissed with with internally-valid assessment tools. Over diagnosing can lead to over-medication, which from an addictions treatment perspective is a worst-case scenario and a poor outcome.

It is essential that Substance Abuse Professionals, regardless of our backgrounds, be able to recognize the symptoms of acute intoxication and withdrawal. We also need to understand the differences between them and mental health disorders and symptoms. If you think you could use some support in the area, please seek out supervision and training. Our clients are counting on us!