Dual Diagnosis

Patients who have both a psychiatric disorder and a substance abuse problem cause most clinicians to throw up their hands in despair. The clinical problems that these "dual diagnosis" patients present are enor mously complex. Diagnostically, how is one to tell if disorders of mood and thinking, for instance, are signs of a mental illness or consequences of substance abuse? How is one to obtain important historic information when the patient may be unable or unwilling to provide it and there are no readily available collateral sources of information? In any case, why bother? Treatments for dually diagnosed patients are ineffective; patients won't stay in treatment; recidivism occurs at a very high rate. To make matters even more difficult, traditional health care reim bursement mechanisms do not provide for the multimodality clinical programs and special services needed by the patient who is both mentally ill and a substance abuser. So the clinician needs an effective bureaucratic strategy as well as a treatment strategy. For the most part, clinicians have handled the problem by ignoring it.

I Evaluation and Diagnosis of Dual Diagnosis Patients.- 1 Introduction and General Concepts of Dual Diagnosis.- 2 Diagnosis and Differential Diagnosis of Psychiatric and Substance Use Disorders.- 3 Recognizing Dual Diagnosis Patients in Various Clinical Settings.- II Treatment of Dual Diagnosis Patients.- 4 Management of Acute Problems in the Dual Diagnosis Patient: Substance Use and Psychiatry.- 5 The Long-Term Treatment of the Dually Diagnosed.- 6 The Role of Self-Help Groups in the Treatment of the Dual Diagnosis Patient.- 7 Countertransference and Attitudes in the Context of Clinical Work with Dually Diagnosed Patients.- 8 Modified Therapeutic Communities for Dual Disorders.- 9 Inpatient Treatment for the Dually Diagnosed: A Peer-Led Model for Acute and Intermediate Care.- 10 Special Considerations for Dually Diagnosed Schizophrenics and Their Families.- 11 Adolescent Dual Diagnosis.- III Program Development, Training, and Research in Dual Diagnosis.- 12 Program Development: Organizing Clinical Innovations.- 13 Developing Dual Diagnosis Treatment Services within Existing Outpatient Psychiatric and Addictive Disorder Programs.- 14 Dual Diagnosis Training: An Integrated Curriculum Design and Implementation.- 15 Research Issues in Dual Diagnosis.