| Dual Diagnosis, Dual Disorders and MoreThe term dual | | | | impairment in functioning may also vary.Thus, there is |
| diagnosis is a common, broad term that indicates the | | | | no single combination of dual diagnosis; in fact, there is |
| presence of two independent medical disorders. | | | | great variability among them. However, patients with |
| Recently, within the fields of mental health, psychiatry, | | | | similar combinations of dual diagnosis are often |
| and addiction medicine, the term has been popularly | | | | encountered in certain treatment settings. For instance, |
| used to describe the coexistence of a mental health | | | | some methadone treatment programs treat a high |
| disorder and drug addiction / alcohol addiction | | | | percentage of opiate-addicted patients with personality |
| problems. The equivalent phrase dual disorders also | | | | disorders. Patients with schizophrenia and alcohol |
| denotes the coexistence of two independent (but | | | | addiction are frequently encountered in psychiatric |
| invariably interactive) disorders, and is the preferred | | | | units, mental health centers, and programs that provide |
| term used in this Treatment Improvement Protocol | | | | treatment to homeless patients. Dual Diagnosis: Drug |
| (TIP). | | | | Addiction and Alcoholism |
| The acronym MICA, which represents the phrase | | | | Patients with mental disorders have an increased risk |
| mentally ill chemical abusers, is occasionally used to | | | | for drug addiction / alcohol addiction disorders, and |
| designate people who have an drug addiction / | | | | patients with AOD disorders have an increased risk |
| alcoholism disorder and a markedly severe and | | | | for mental disorders. For example, about one-third of |
| persistent mental disorder such as schizophrenia or | | | | patients who have a psychiatric disorder also |
| bipolar disorder. A preferred definition is mentally ill | | | | experience drug abuse at some point (Regier et al., |
| chemically affected people, since the word affected | | | | 1990), which is about twice the rate among people |
| better describes their condition and is not pejorative. | | | | without psychiatric disorders. Also, more than half of |
| Other acronyms are also used: MISA (mentally ill | | | | the people who suffer from drug abuse or alcohol |
| substance abusers), CAMI (chemical abuse and mental | | | | abuse have experienced psychiatric symptoms |
| illness), and SAMI (substance abuse and mental illness). | | | | significant enough to fulfill diagnostic criteria for a |
| Dual Diagnosis ExamplesCommon examples of dual | | | | psychiatric disorder (Regier et al., 1990; Ross et al., |
| diagnosis include the combinations of major depression | | | | 1988), although many of these symptoms may be |
| with cocaine addiction, alcohol addiction with panic | | | | AOD related and might not represent an independent |
| disorder, alcoholism and heroin addiction with | | | | condition. Compared with patients who have a mental |
| schizophrenia, and borderline personality disorder with | | | | health disorder or an drug abuse or alcohol abuse |
| episodic drug abuse. | | | | problem alone, patients with dual diagnosis often |
| Although the focus of this volume is on dual diagnosis, | | | | experience more severe and chronic medical, social, |
| some patients have more than two disorders, such as | | | | and emotional problems. Because they have two |
| cocaine addiction, personality disorder, and AIDS. The | | | | disorders, they are vulnerable to both AOD relapse |
| principles that apply to dual diagnosis generally apply | | | | and a worsening of the psychiatric disorder. Further, |
| also to multiple disorders. The combinations of drug | | | | addiction relapse often leads to psychiatric |
| addiction / alcohol addiction problems and psychiatric | | | | decompensation often leads to addiction relapse. Thus, |
| disorders vary along important dimensions, such as | | | | relapse prevention must be specially designed for |
| severity, chronicity, disability, and degree of impairment | | | | patients with dual diagnosis. Compared with patients |
| in functioning. For example, the two disorders may | | | | who have a single disorder, patients with dual diagnosis |
| each be severe or mild, or one may be more severe | | | | often require longer treatment, have more crises, and |
| than the other. Indeed, the severity of both disorders | | | | progress more gradually in treatment. |
| may change over time. Levels of disability and | | | | |