Treating Dual Diagnosis Patients: Challenges and Opportunities

T he use and abuse of drugs and alc ohol ha ve recently gained grea ter attention both from the public and the medical profession . Desp ite increasing cognizance of its un fo r tunate consequences, substance use has become a more pervasive element of conte mporary society. As substance abuse ha s come to affect more segments of the population, it is not surprising that this problem a lso has affected the mentally ill. Awareness of the mentally ill subs ta nce ab user ha s grown , a lthough this population has not been well studied or well served by th e mental health system . These dually diagnosed patients often a re depict ed as the square pegs of psychiatry, not quite fitting into the round hol e of menta l health treatment. The reason for this is clear. Because of the curren t structure of th e mental health service delivery syste m , psychiatric and subs tance abuse services are provided almost exclusivel y by independent syste ms (1 ,2). As a result , those patients who are perhaps most in need of treatment are most likel y to fall through the cracks of the system. Providing services for this group of patients represents a clinical and administrative challenge, wh ich has no t bee n adequately addressed by the psychiatric profession . In this paper, I suggest that psychiatrists can accept greater responsibility for working with th e d ually di agnosed , and that this responsibility could begin with th e psych iatrist-i n-tra in ing. Although the prob lem may be difficult to overcome, psychiatry is in a unique position to accept this responsibility, effect changes in th e syste m , and have a positive impact on the lives of patients with dual diagnoses.