Dual diagnosis

Kranzler HR, Rosenthal RN Dual diagnosis alcoholism and co-morbid psychiatric disorders. Am J Addict 12 (suppl 1) S26—S40, 2003 Kranzler HR, Tinsley JA (eds) Dual Diagnosis Substance Abuse andComorbid Medical and Psychiatric Disorders, 2nd Edition. New York, Marcel Dekker, 2004... 

Co-occurring disorders. The occurrence of other disorders along with the drug problem also called dual diagnosis or comorbid disorders. 

Sending that same patient to a drug treatment program with no help for the depression is not much better. A structured dual diagnosis program, which treats both the addiction and the depression, has the best chance of helping the patient. 

It is also important to know about comorbid psychiatric disorders. If these are overlooked, treating the substance use disorder becomes significantly more difficult. Recognizing this, most treatment centers have developed dual diagnosis programs to treat those patients who have another major psychiatric illness in addition to a substance use disorder. It may be virtually impossible to discern at first, but the other psychiatric illnesses might either contribute to or be a result of substance use. The social toll of alcoholism alone can trigger a severe clinical depression. However,... 

Wise, B., Cuffe, S., and Fischer T. (2001) Dual diagnosis and successful participation of adolescents in substance abuse treatment. Journal of Substance Abuse Treatment 219 161-165. 

Treatment of anxiety disorders in children with psy-chopharmacologic agents has become much more common in the past decade. There are few studies of the use of these drugs in typically developing children and even fewer in children with MR. Most recommendations are based on experience with adults with a dual diagnosis or with typically developing children. The classes of medications used for the treatment of anxiety disorders include SSRIs, benzodiazepines, TCAs, and buspirone. In the Expert Consensus Guidelines (Rush and Frances, 2000), the SSRIs were rated as a first-line treatment for anxiety disorders. Buspirone was also a first-line treatment, with the benzodiazepines considered second line. 

Bruininks, R.H., Hill, B.K., and Morteau, L.E. (1988) Ptevalence and implications of maladaptive behaviots and dual diagnosis in tes-idential and othet service programs. In Stark, J.A., Menolascino, F.J., Albarelli, M.H., and Gray, V.C., eds. Mental Retardation and Mental Health. Classification, Diagnosis, Treatment, Services. New York Springer-Verlag, pp. 3-29. 

A group of clinical researchers in New Hampshire, USA, who are highly experienced in the treatment of substance abuse in the severely mentally ill have identified certain key principles of management (Drake et al. 1993, 2001), which are shown in Table 7.4. They consider that a special approach is necessary because the severely mentally ill do not identify problems in the same way, they typically have difficulty with addiction treatment approaches such as group therapy, and there is an ever-present danger that this group fall between two sets of services. Their work is in a unit specifically for dual diagnosis patients. 

The same New Hampshire group have described continuous treatment teams (Drake et al. 1996), who treat the dual diagnosis patients, with 24-hour responsibility for case management. There is a flexible approach to individual and group therapy, the latter being either educational or treatment-oriented in the case of those committed to abstinence. There is a practical focus on social situation, social skills and aspects of daily living. 

Abou-Saleh MT (2007). Dual diagnosis management within a psychosocial context. In Day E (ed.) Clinical Topics in Addiction. London RCPsych Publications, pp. 169-83 Abraham HD Aldridge AM (1993). Adverse consequences of lysergic acid diethylamide. Addiction, 88, 1327-34... 

Drake RE, Essock SM Shaner A (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 57, 469-76... 

Johnson S (1997). Dual diagnosis of severe mental illness and substance misuse a case for specialist services. British Journal of Psychiatry, 171, 205-8... 

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