Psychosocial approaches to dual diagnosis

Recent research elucidates many aspects of the problem of co-occurring substance use disorder (SUD) in patients with severe mental illness, which is often termed dual diagnosis. This paper provides a brief overview of cur-rent research on the epidemiology, adverse conse-quences, and phenomenology of dual diagnosis, followed by a more extensive review of current approaches to ser-vices, assessment, and treatment. Accumulating evidence shows that comorbid SUD is quite common among indi-viduals with severe mental illness and that these individ-uals suffer serious adverse consequences of SUD. The research further suggests that traditional, separate ser-vices for individuals with dual disorders are ineffective, and that integrated treatment programs, which combine mental health and substance abuse interventions, offer more promise. In addition to a comprehensive integra-tion of services, successful programs include assessment, assertive case management, motivational interventions for patients who do not recognize the need for substance abuse treatment, behavioral interventions for those who are trying to attain or maintain abstinence, family inter-ventions, housing, rehabilitation, and psychopharmacol-ogy. Further research is needed on the organization and financing of dual-diagnosis services and on specific com-ponents of the integrated treatment model, such as group treatments, family interventions, and housing approaches