Abstract
Dual diagnosis in psychiatry and addiction refers to the presence of a substance use disorder coexisting with another major psychiatric disorder. This article reviews the prevalence and timing of occurrence of the various disorders and their combinations. The problems in diagnosis and management associated with these diagnoses are explored both from the point of view of the patient and of the treatment providers. The paper outlines a general management strategy for dual diagnosis cases and discusses specific strategies for treating particular psychiatric diagnosis combinations.
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References
Gitlow SE: Alcoholism: A disease (p. 235), in Alcoholism: Progress in Research and Treatment. Edited by Bourne PG, Fox R. New York, Academic Press, 1973.
Tiebout, HM: Intervention in psychotherapy. American Journal of Psychoanalysis 33:1–6, 1982.
Bratter TE: Special clinical psychotherapeutic concerns for alcoholic and drug addicted individuals (p. 523–529), in Alcoholism and Substance Abuse: Strategies for Clinical Intervention. Edited by Bratter TE, Forrest G. New York, Free Press, 1985.
Helzer JE, Pryzbeck TR: The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol 49: 219–224, 1988.
Ross, HE, Glaser FB, Germanson T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry 45: 1023–1031, 1988.
Hesselbrock MN, Meyer RE, Keener JJ: Psychopathology in hospitalized alcoholics. Archives of General Psychiatry 42: 1050–1055, 1985.
Hall HC, Popkin MK, Stickney SK, et al: Covert outpatient drug. Journal of Nervous and Mental Diseases 166: 343–348, 1978.
Crowley TJ, Chesluk D, Dilts S, et al: Drug and alcohol abuse among psychiatric admissions—a multidrug clinical toxicologic study. Archives of General Psychiatry 30: 13–20, 1974.
Blumberg AG, Cohen M, Heaton AM, et al: Covert drug abuse among voluntary hospitalized psychiatric patients. Journal of the American Medical Association 217: 1659–1661, 1971.
Schuckit MA: Genetic and clinical implications of alcoholism and affective disorder. American Journal of Psychiatry 143: 140–147, 1986.
Schuckit MA: Alcoholism and other psychiatric disorders. Hospital and Community Psychiatry 34: 1022–1027, 1983.
Schuckit MA: Alcoholism and sociopathy-diagnostic confusion. Quarterly Journal of the Studies on Alcohol 34: 157–164, 1973.
Cadoret R, Troughton E, Widmer R: Clinical differences between antisocial and primary alcoholics. Comprehensive Psychiatry 25: 1–8, 1984.
Powell BJ, Penick EC, Othmer E, et al: Prevalence of additional psychiatric syndromes among male alcoholics. Journal of Clinical Psychiatry 43 (10):404–407, 1982.
Kosten TR, Roundsaville BJ, Kleber HD: DSM-III personality disorders in opiate addicts. Comprehensive Psychiatry 23 (6):572–581, 1982.
Nace EP, Saxon JJ, Shore N: A comparison of borderline and non borderline alcoholic patients. Archives of General Psychiatry 40:54–56, 1983.
Safer DJ: Substance abuse by young chronic patients. Hospital and Community Psychiatry 38:511–513, 1987.
Bergman HC, Harris M: Substance use among young chronic patients. Psychosocial Rehabilitation Journal 9 (1):49–54, 1985.
Schneier FR, Siris SA: Review of psychoactive substance use and abuse in schizophrenia, patterns of drug choice. The Journal of Nervous and Mental Disease 175:641–652, 1987.
Drake RE, Wallach MA: Substance abuse among the chronic mentally ill. Hospital and Community Psychiatry 40 (10):1040–1049, 1989.
Hasin D, Endicott J, Lewis C: Alcohol and drug abuse in patients with affective syndromes. Comprehensive Psychiatry 26:283–295, 1985.
Liskow B, Mayfield D, Thiele J: Alcohol and affective disorder: Assessment and treatment. Journal of Clinical Psychiatry 43:144–147, 1982.
Morrison JR: Bipolar affective disorder and alcoholism. American Journal of Psychiatry 131:1130–1133, 1974.
Dunner DL, Hensel BM, Fieve RR: Bipolar illness: Factors in drinking behavior. American Journal of Psychiatry 136:583–585, 1979.
Sherfey MJ: Psychopathology and character structure in chronic alcoholism, in Etiology of Chronic Alcoholism, Edited by Diethelm E. Springfield, Illinois, Charles C. Thomas, 1955.
Stenstedt A: A Study in manic depressive psychoses. Acta Psychiatric Neurologica Scandinavica (suppl) 79:3–11, 1952.
Goodwin D: Substance abuse linked with bipolar illness. Psychiatric News, p6, July 1990.
Mayfield DG: Alcohol and affect: Experimental studies, in Alcoholism and Affective Disorders. Edited by Goodwin DW, Erickson CK. New York, SP Medical and Scientific Books, 1979.
Lewis CE, Helzer J, Cloninger CR, et al: Psychiatric diagnostic predispositions to alcoholism. Comprehensive Psychiatry 23:451–461, 1982.
Keller MB, Lavori PE, Lewis CE, et al. Predictors of relapse in major depressive disorder. Journal of the American Medical Association 250:3299–3304, 1983.
Thyer BA, Parrish R.T., Himle J, et al: Alcohol use among clinically anxious patients. Behavior Research and Therapy 24:357–359, 1986.
Bibb JL, Chambless DL: Alcohol use and abuse among diagnosed agoraphobics. Behavior Research and Therapy 24 (1):49–58, 1986.
Smail P, Stockwell T, Canter S, et al: Alcohol dependence and phobic anxiety states 1: A prevalence study. British Journal of Psychiatry 144:53–57, 1984.
Eisen JL, Rasmussen SA: Coexisting obsessive compulsive disorder and alcoholism. Journal of Clinical Psychiatry 50:396–98, 1989.
Quitkin FM, Rifkin A, Kaplan J, et al: Phobic anxiety syndrome complicated by drug dependence and addiction. Archives of General Psychiatry 27:159–162, 1972.
Boman B: Combat stress, post traumatic stress disorder, and associated psychiatric disturbance. Psychosomatics 27(8):567–573, 1986.
Egendorf A: The postwar hell of Vietnam veterans: Recent research. Hospital and Community Psychiatry 35:901–907, 1982.
Sierles FS, Chen JJ, McFarland RE, et al: Post-traumatic stress disorder in concurrent psychiatric illness: A preliminary report. American Journal of Psychiatry 140:1177–1179, 1983.
Powers PS, Coovert DL, Brightwell DR, et al: Other psychiatric disorders among bulimic patients. Comprehensive psychiatry 29:503–508, 1988.
Newman, M: Substance abuse and anorexia nervosa and bulimia nervosa. In Dual Diagnosis in Substance Abuse. Edited by Gold M. Slaby A. New York, Marcel Dekker Inc., 1991.
Kofoed I, Kania J, Walsh T, et al: Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders. American Journal of Psychiatry 143:867–872, 1986.
Pinsker H: Addicted patients in hospital psychiatric units. Psychiatric Annals 13:619–623, 1983.
McLellan AT, Alterman A, Grissom G: Patient-Treatment “Matching”: Role of Treatment Services, presented at the 53rd Annual Scientific Meeting of the Committee on Problems of Drug Dependence, June 1991.
Kofoed L, Keys A: Using group therapy to persuade dual diagnosis patients to seek substance abuse treatment. Hospital and Community Psychiatry 39:1209–1211, 1988.
Brown SA, Irwin M, Schuckit MA: Changes in anxiety among abstinent male alcoholics. Journal of Studies on Alcohol 52 (1):55–61, 1991.
Sheehan MF, Sheehan DV, Torres A, et al: Snorting benzodiazepines. American Journal of Drug and Alcohol Abuse 17 (4):457–468, 1991.
Ciraulo DA, Sands BF, Shader RI: Critical review of liability for benzodiazepine abuse among alcoholics. American Journal of Psychiatry 145:1501–1506, 1988.
Malka R. Role of drug therapies in the treatment of alcoholism: Alcohol and anxiety—alcohol and depression. Clinical Neuropharmacology 11:S69-S73, 1988.
Nace EP: Alcoholism and other psychiatric disorders, in The Treatment of Alcoholism. New York, Brunner Mazel, 1987.
Louie AK, Lannon R, Ketter T: Treatment of cocaine induced panic disorder. American Journal of Psychiatry 146 (1):40–44, 1989.
Sheehan DV, Raj BA, Harnett-Sheehan K, et al: Is buspirone effective in panic disorder? Journal of Clinical Psychopharmacology 10 (1):3–1, 1990.
Ciraulo DA, Alderson LM, Chapron DJ, et al: Imipramine disposition in alcoholics. Journal of Clinical Psychopharmacology 2 (1):2–7, 1982.
Kosten TR: Advances in clinical research on drug addiction: Opioids and cocaine. Substance Abuse 10:35–42, 1989.
Brown SA, Schuckit MA: Changes in depression among abstinent alcoholics. Journal of Studies on Alcohol 49:412–417, 1988.
Brady K, Anton R, Ballenger J, et al: Cocaine abuse among schizophrenic patients. American Journal of Psychiatry 147(9):1164–1167, 1990.
Panepinto WC, Higgins MJ, Keane Dawes WY, et al: Underlying psychiatric diagnosis as an indicator of participation in alcoholism therapy. Quarterly Journal of the Study of Alcoholism 31:950–956, 1970.
Tarter R, Ryan C: Neuropsychology of alcoholism, etiology, phenomenology, process and outcome, in Recent Developments in Alcoholism. Edited by Galanter M. New York, Plenum, 1983.
Eckardt MJ, Martin PR: Clinical assessment of cognition in alcoholism. Alcoholism Clinical and Experimental Research 10(2):128–137, 1986.
Meek PS, Clarke HW, Solana VL: Neurocognitive impairment: The unrecognized component in dual diagnosis in substance abuse treatment. Journal of Psychoactive Drugs 21(2):153–160, 1989.
Wender PH, Reimherr FW, Wood DR: Attention deficit disorder in adults. Archives of General Psychiatry 38:449–456, 1981.
Gawin FH, Kleber HD: Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Archives of General Psychiatry 43:107–113, 1986.
Khantzian EJ: Cocaine dependence: An extreme case and marked improvement with methylphenidate treatment. American Journal of Psychiatry 140:784–785, 1983.
O'Malley S, Kosten TR, Renner JA: Dual Diagnoses: Substance abuse and personality disorders, in New Directions for Mental Health Services 47:115–137, Jossey Bass Inc., Fall 1990.
Evans K, Sullivan JM: Selected personality disorders, in Dual Diagnosis: A Guide for Counsellors and Case Managers, New York, Guilford Press, 1990.
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Sheehan, M.F. Dual diagnosis. Psych Quart 64, 107–134 (1993). https://doi.org/10.1007/BF01065865
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DOI: https://doi.org/10.1007/BF01065865