Skip to main content Accessibility help
×
Home

Dual diagnosis: management within a psychosocial context

  • Mohammed T. Abou-Saleh

Abstract

Recent developments in UK government policy have highlighted the unmet needs of people with dual diagnosis (comorbidity of substance misuse and psychiatric disorder, particularly severe mental illness). Advances in assessment techniques and diagnostic practice have informed the treatment of comorbidity and improved its outcome. There is growing evidence for the effectiveness of psychosocial interventions such as motivational interviewing and cognitive–behavioural therapy, mostly from US studies. However, within the secondary care provided by addiction and general psychiatric services there are serious implementation barriers related to service organisation, staffing levels, training and – most importantly – the difficulties of engaging people with severe mental illness and comorbid substance misuse in treatment. The evidence for the effectiveness of psychosocial treatments and models of service is reviewed and challenges for optimal practice in the UK are highlighted.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dual diagnosis: management within a psychosocial context
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dual diagnosis: management within a psychosocial context
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dual diagnosis: management within a psychosocial context
      Available formats
      ×

Copyright

References

Hide All
Abou-Saleh, M. T. (2000) Substance misuse and comorbid psychiatric disorders. CPD Bulletin in Psychiatry, 2, 6167.
American Psychiatric Association (1993) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Appleby, L., Dyson, V., Altman, E. et al (1996) Utility of the chemical use, abuse, and dependence scale in screening patients with severe mental illness. Psychiatric Services, 47, 647649.
Babor, T. F., de la Fuente, J. R., Saunders, J. et al (1992) AUDIT: The Alcohol Use Disorders Identification Test. Geneva: World Health Organization.
Barrowclough, C., Haddock, G., Tarrier, N. et al (2001) Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry, 158, 17061713.
Brooner, R. K., Kidorf, M., King, V. L. et al (1998) Preliminary evidence of good treatment response in antisocial drug abusers. Drug and Alcohol Dependence, 49, 249260.
Chambers, R. A., Krystal, J. H. & Self, D. W. (2001) A neurobiological basis for substance abuse comorbidity in schizophrenia. Biological Psychiatry, 50, 7183.
Cornelius, J. R., Salloum, I. M., Cornelius, M. D. et al (1997) Fluoxetine in depressed alcoholics: a double blind placebo-controlled trial. Archives of General Psychiatry, 54, 700705.
Crawford, V. & Crome, I. (2001) Co-existing Problems of Mental Health and Substance Misuse (Dual Diagnosis ): A Review of Relevant Literature. London: Royal College of Psychiatrists.
Crome, I. B. & Myton, T. (2004) Pharmacotherapy in dual diagnosis. Advances in Psychiatric Treatment, 10, in press.
Department of Health (2001) Safety First: Five-Year Report of the National Confidential Inquiry Into Suicide and Homicide by People With Mental Illness. London: Department of Health.
Department of Health (2002a) Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. London: Department of Health.
Department of Health (2002b) Adult Acute Inpatient Care Provision Guidance. London: Department of Health.
Department of Health (2002c) National Minimum Standards for Psychiatric Intensive Care Units and Low Secure Environments. London: Department of Health.
Department of Health (2003) Personality Disorder: No Longer a Diagnosis of Exclusion. London: Department of Health.
Drake, R. E., Bartels, S. J., Teague, G. B. et al (1993) Treatment of substance abuse in severely mentally ill patients. Journal of Nervous and Mental Disease, 181, 606611.
Drake, R. E., McHugo, G. J., Clark, R. E. et al (1998) Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. American Journal of Orthopsychiatry, 68, 0000.
Drake, R. E., Mercer-McFadden, C. & Mueser, K. T. (1998) Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589608.
Drake, R. E. & Mueser, K. T. (2000) Psychosocial approaches to dual diagnosis. Schizophrenia Bulletin, 26, 105117.
Edwards, J., Hinton, M., Elkins, L. et al (2003) Cannabis and first-episode psychosis: the Cap Project. In Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery. Chichester: John Wiley & Sons.
Farrell, M., Howes, S., Bebbington, P. et al (2001) Nicotine, alcohol and drug dependence and psychiatric comorbidity. Results of a national household survey. British Journal of Psychiatry, 179, 432437.
Folstein, M. F., Folstein, S.E. & McHugh, P. R. (1975) ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Galanter, M., Egelko, S., Edwards, H. et al (1994) A treatment system for combined psychiatric and addictive illness. Addiction, 89, 12271235.
Graham, H. L., Copello, A., Birchwood, M. J. et al (2003) Cognitive-behavioural integrated treatment approach for psychosis and problem substance use. In Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery. Chichester: John Wiley & Sons.
Harrison, C. & Abou-Saleh, M. T. (2002) Psychiatric disorders and substance misuse psychopathology In Dual Diagnosis, pp. 4357. Oxford: Blackwell.
Hasin, D., Trautman, K., Miele, G. et al (1996) Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability in substance abusers. American Journal of Psychiatry, 153, 11951201.
Johnson, S. (1997) Dual diagnosis of severe mental illness and substance misuse: a case for specialist services? British Journal of Psychiatry, 171, 205208.
Kavanagh, D. J., Young, R., White, A. et al (2003) Start over and survive: a brief intervention for substance misuse in early psychosis. Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery. Chichester: John Wiley & Sons.
Ley, A., Jeffrey, D. P., McLaren, S. et al (1999) Treatment programmes for those with both severe mental illness and substance misuse. Cochrane Library, issue 4, 119. Oxford: Update Software.
Maslin, J., Graham, H. L., Cawley, M. et al (2001) Combined severe mental health and substance use problems. What are the training and support needs of staff working with this client group? Journal of Mental Health, 10, 131140.
McHugo, G. J., Drake, R. E., Burton, H. L. et al (1995) A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. Journal of Nervous and Mental Disease, 183, 762767.
McHugo, G. J., Drake, R. E., Teague, G. B. et al (1999) Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818824.
McPhillips, M. A., Kelly, F. J., Barnes, T. E. et al (1997) Detecting co-morbid substance abuse among people with schizophrenia in the community: a study comparing the results of questionnaires with analysis of hair and urine. Schizophrenia Research, 25, 141148.
Mind in Croydon (2004) Pillar to Post. A Film about Dual Diagnosis. Video available from http://www.mindincroydon.org.uk/videos.asp
Mueser, K. T., Bellack, A. S. & Blanchard, J. J. (1998) Comorbidity of schizophrenia and substance abuse: Implications for treatment. Journal of Consulting and Clinical Psychology, 60, 845856.
Noordsy, D. L., McQuade, D. V. & Mueser, K. T. (2003) Assessment considerations. In Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery (eds Graham, H. L., Copello, A., Birchwood, M. J. et al). Chichester: John Wiley & Sons.
Rosenberg, S. D., Drake, R. E., Wolford, G. L. et al (1998) Dartmouth Assessment of Lifestyle Instrument (DALI): a substance use disorder screen for people with severe mental illness. American Journal of Psychiatry, 155, 232238.
Rounsaville, B. J., Kosten, T. R., Weissman, M. M. et al (1986) Prognostic significance of psychopathology in treated opiate addicts. A 2.5 year follow-up study. Archives of General Psychiatry, 43, 739745.
Saxon, A. J. & Calsyn, D. A. (1995) Effects of psychiatric care for dual diagnosis patients treated in a drug dependence clinic. American Journal of Drug and Alcohol Abuse, 21, 303313.
Skinner, H. (1982) The Drug Abuse Screening Test. Addictive Behavior, 7, 363371.
Van den Bosch, L. M., Verheul, R., Schippers, G. M. et al (2002) Dialectical behavior therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addictive Behavior, 27, 911923.
Weiss, R. & Najavits, L. (1998) Overview of treatment modalities for dual diagnosis patients: pharmacotherapy, psychotherapy, and 12-step programmes. In: Dual Diagnosis and Treatment: Substance Abuse and Comorbid Medical and Psychiatric Disorders. (eds Kranzler, H. & Rounsaville, B.) p. 87. New York: Marcel Dekker.
Weiss, R. D., Griffin, M. L., Greenfield, S. F. et al (2000) Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. Journal of Clinical Psychiatry, 61, 361367.
Woody, G. E., Luborsky, L., McLellan, A. T. et al (1985) Psychotherapy for opiate dependence. NIDA Research Monograph, 58, 929.

Related content

Powered by UNSILO

Dual diagnosis: management within a psychosocial context

  • Mohammed T. Abou-Saleh

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Dual diagnosis: management within a psychosocial context

  • Mohammed T. Abou-Saleh
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *