Dual diagnosis: current situation and challenges for the future

Authors

  • Marta Torrens Mèlich Directora de la Línea de Adicciones. Institut d’Atenció Psiquiàtrica, Salut Mental i Addiccions (IAPS)-Hospital del Mar, Universitat Autònoma Barcelona. Enviar correspondencia a: Marta Torrens Mèlich. Institut d’Atenció Psiquiàtrica, Salut Mental i Addiccions (IAPS)-Hospital del Mar, Passeig Marítim 25−29. 08003 Barcelona

DOI:

https://doi.org/10.20882/adicciones.255

Keywords:

dual diagnosis, psychiatric comorbidity, psychiatric co-occurrence, substance use disorder, addiction

Abstract

The term "dual diagnosis" refers to the co-occurrence of at least one substance use disorder with another psychiatric disorder in the same individual. These "dual" patients or patients with psychiatric comorbidity are common, and present greater severity from both the clinical and social perspectives than those subjects with only one type of disorder (addictive or other psychiatric illness). We present the current situation regarding dual diagnosis from epidemiological, clinical and therapeutic perspectives and we review the most important challenges for the future. Among the challenges for the future, we highlight: the need to improve the understanding of the nosological characterisation of the co-occurrence of psychopathological symptoms and the use, intoxication and withdrawal from substances; the need for clinical screening instruments to detect dual diagnosis; the need to develop effective therapeutic strategies both pharmacological and psychological; the importance of providing integrated care to these patients by one therapeutic team within a single mental health and addiction network; and finally, the need to incorporate training on dual diagnosis for health professionals.

References

Martín-Santos R, Fonseca F, Domingo-Salvany A, Ginés JM, Imaz ML, Navinés R, et al. Dual diagnosis in the psychiatric emergency room in Spain. European J Psychiatry 2006; 20:147-156.

Aharonovich E, Liu X, Nunes E, Hasin DS. Suicide attempts in substance abusers: effects of major depression in relation to substance use disorders. Am J Psychiatry 2002; 159:1600-1602.

King VL, Kidorf MS, Stoller KB, Brooner RK. Influence of psychiatric comorbidity on HIV risk behaviors: changes during drug abuse treatment. J Addict Dis 2000; 19: 65-83.

Carey MP, Carey KB, Maisto SA, Gordon CM, Vanable PA. Prevalence and correlates of sexual activity and HIVrelated risk behaviour among psychiatric outpatients. J Consult Clin Psychol 2001; 69: 846-850.

Rosenberg SD, Goodman LA, Osher FC, Swartz MS, Essock SM, Butterfield MI, et al. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. Am J Public Health 2001; 91: 31-37.

Caton CL, Shrout PE, Eagle PF, Opler LA, Felix A, Dominguez B. Risk factors for homelessness among schizophrenic men: a case-control study. Am J Public Health 1994; 84: 265-270.

Vazquez C, Munoz M, Sanz J. Lifetime and 12-month prevalence of DSM-III-R mental disorders among the homeless in Madrid: a European study using the CIDI. Acta Psychiatr Scand 1997; 95: 523-530.

Abram KM, Teplin LA. Co-occurring disorders among mentally ill jail detainees: implications for public policy. Am Psyhologist. 1991; 4: 1036-1045.

Cuffel B, Shumway M, Chouljian T. A longitudinal study of substance use and community violence in schizophrenia. J Nerv Mental Dis, 1994; 182: 704-708.

Flynn PK, Brown BS. Co-occurring disorders in substance abuse treatments: Issues and prospects. J Subst Abuse Treat 2008; 34: 36-47.

Rodriguez-Llena MC, Domingo-Salvany A, Brugal MT, Silva TC, Sánchez-Nubió A, Torrens M. Psychiatric comorbidity in young heroin users. Drug Alcohol Depend 2006; 84: 48-55.

Nocon A, Bergé D, Astals M, Martín-Santos R, Torrens M. Dual diagnosis in an inpatient drug-abuse detoxification unit. Eur Addict Res 2007; 13:192-200.

Herrero MJ, Domingo-Salvany A, Torrens M, Brugal MT; ITINERE Investigators. Psychiatric comorbidity in young cocaine users: induced versus independent disorders. Addiction. 2008; 103:284-93.

Casas M, Gual A. Patología psiquiátrica asociada al alcoholismo. Adicciones 2002; 14 (Supl 1): 195-219.

Feighner JP, Robins E, Guze SB, Woodruff RA Jr, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972; 26:57-63.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed -TR. Washington, DC: American Psychiatric Press, 2000.

Organización Mundial de la Salud. Décima Revisión de la Clasificación Internacional de las Enfermedades. Trastornos mentales del comportamiento y desarrollo. Descripciones clínicas y pautas para el diagnóstico. Madrid: Meditor, 1992.

Torrens M, Martin-Santos R, Samet S. Importance of clinical diagnoses for comorbidity studies in substance use disorders. Neurotox Res 2006;10:253-61.

Torrens M, Serrano D, Astals M, Pérez-Domínguez G, Martín-Santos R. Diagnosing Psychiatric Comorbidity in Substance Abusers. Validity of the Spanish Versions of Psychiatric Research Interview for Substance and

Mental Disorders (PRISM-IV) and the Structured Clinical Interview for DSM-IV (SCID-IV). Am J Psychiatry. 2004; 161: 1231-1237.

Hasin DS, Samet S, Nunes E, Meydan J, Matseoane K, Waxman R. Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV. Am J Psychiatry 2006; 163: 689-96.

Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry 2005; 162:1483-93.

Saunder JB, Schuckit MA, Sirovatka PJ, Regier Da (Eds.). Diagnostic issues in substance use disorders. Refining the research agenda fro DSM-V. Arlington,: American Psychiatric Press, 2007.

Mateu G, Astals M, Torrens M. Comorbilidad psiquiátrica y trastorno por dependencia de opiáceos: del diagnóstico al tratamiento. Adicciones 2005; 17 (Supl 2): 111-121.

Green AI, Noordsy DL, Brunette MF, O’Keefe C. Substance abuse and schizophrenia: Pharmacotherapeutic intervention. J Subst Abuse Treat 2008; 34:61-71.

Drake RE, O’Neal EL, Wallach MA. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. J Subst Abuse Treat 2008; 34: 123-128.

Drake RE, Wallach MA, McGovern MP. Future directions in preventing relapse to substance abuse among clients with severe mental illness. Psychiatric Services, 2005; 56: 1297–1302.

Published

2008-12-01

Issue

Section

Editorial