Substance abuse and the chronically mentally ill: A description of dual diagnosis treatment services in a psychiatric hospital

Abstract

Between 20% and 70% of psychiatric patients have a co-occurring substance use disorder and rates of substance abuse among patients with psychotic disorders are especially high. Patients with co-existing psychosis and substance use disorders typically have poorer outcomes than patients diagnosed with either disorder alone. Frequently, treatment services for such dually diagnosed patients are not integrated and organizational barriers may impede the appropriate detection, referral, and treatment of these patients. This article reviews the epidemiology and treatment outcome for patients dually diagnosed with chronic mental illness (usually psychotic disorders) and substance use disorders. The article then presents a description of a dual diagnosis referral and treatment service in a large private, non-profit psychiatric hospital.

Double trouble in recovery: Self-help for people with dual diagnoses.

“…There is a high prevalence of persons diagnosed with both a psychiatric disability and a chemical dependency in the United States, as evidenced by both epidemiological data and studies of treatment-seekers in substance abuse and mental health programs (Dixon, Haas, Weiden, Sweeney & Frances, 1991;Gawin & Kleber, 1985;Greenfield, Weiss & Tohen, 1995;Hesselbrock, Meyer & Keener, 1985;Kleinman, Miller & Millman, 1990;Marlowe et al, 1995;Mirin, Weiss & Michael, 1988;Rounseville, Anton & Carroll, 1991;Rounseville, Kosten, Weissman & Kleber, 1986;Rounseville, Weissman, Kleber & Wilber, 1982;Weiss et al, 1986). There is also evidence that those with lifetime comorbidity are more likely than those with a single disorder to experience major impairments in economic roles (e.g., unemployment, financial problems) and social roles (e.g., social isolation, interpersonal conflicts; see Kessler, 1995).…”

Managing comorbid schizophrenia and substance abuse

“…Inpatient hospitalization, assessment, crisis intervention, medication management, money management, laboratory screening, housing, and vocational rehabilitation incorporate special features that are tailored specifically for dual diagnosis. For example, hospitalization is considered a component of the system that supports movement toward recovery by providing diagnosis, stabilization, and linkage with outpatient dual diagnosis interventions during acute episodes [47]. Similarly, housing and vocational programs can be used to support the dually diagnosed individual in acquiring skills and supports needed for recovery [48].…”

The Development of a Substance Abuse Treatment Program for Forensic Patients With Cognitive Impairment

“…Counselors in forensic psychiatric treatment settings typically provide intensive substance abuse treatment to their patients and frequently need to do so as a condition of discharge to a less restrictive environment (Beck, 2002;Ogloff, 2004;Wheatley, 1998). Given the high comorbidity rates (from 15% to 70%) between substance abuse and severe psychiatric disorders (e.g., schizophrenia; Greenfield, Weiss, & Tohen, 1995;Lehman, Myers, Corty, & Thompson, 1994;Soni et al, 2005;Storch, 1992), substance abuse counseling has been demonstrated to be an important and effective intervention for this population (Brower, Blow, & Beresford, 1989;K. B. Carey, Purnine, Maisto, Carey, & Simons, 2000;Cimino, 2002;Kaufman, 1989;Leach, Hardy, & Dinwiddie, 1998;Levy, 2002;Levy & Mann, 1988;Mowbray et al, 1995).…”