[Severe personality disorders associated with addictive behavior]

After demonstrating the failure of a one dimensional approach to treating addictive behavior coupled with severe personality disorders, the authors suggest an organization of services based on the systemic approach. They recommend a personalized program with both external and internal services. With this in mind, the authors present a program developed by professionals involved in the fields of mental health and addictive behavior. Co-ordinated by a multidisciplinary team, it requires a specific contribution from all members of the team who are involved in different aspects of the person's life. To locate potential users of the program, brochures are sent to CLSCs (community health centres), hospitals, public and private resources, AIDS programs, social workers, and community health workers. Once in treatment, the patient goes through various treatment zones. The first, labelled the reception zone is designated with the initial contact between client and the program. In many instances, a significant other who is close to the client is contacted to take part in the program and help. In the zone of clarification, the client must come to terms with the program and indicate a serious determination to see the program through. The development zone centers on an active reflection of self and the development of new abilities for interpersonal relations, assisting the individual to function autonomously. The goal is for clients to attain a level of self-criticism of their own addiction. The zone of consolidation is optimally reached after about one year in the program. Clients are able to integrate everything learned in the development zone and apply it to their daily life. Community organizations are involved at this stage. The authors conclude that a multidimensional approach, a concerted commitment and a recognition of the contribution of all team members involved in the treatment, are essential elements for tangible results.