Mentally ill chemical abusers or substance-abusing mentally ill persons2

DUAL DIAGNOSIS: The term ?dual diagnosis? denotes the co-occurrence of substance abuse and severe mental illness.4

SUBSTANCE ABUSE: It refers to substance use disorders, which include abuse and dependence. 4

SEVERE MENTAL ILLNESS: It refers to long term psychiatric disorders, such as schizophrenia, that are associated with disability and that fall within the traditional purview of public mental health systems.4

In many ways dual diagnosis is an unfortunate misnomer2.

  • Because the individuals in this group (having dual diagnosis) are heterogeneous (It includes individuals with less disabling mental illnesses such as anxiety disorders, those with different severe illnesses such as schizophrenia and bipolar disorder, and those with either substance abuse or substance dependence) and tend to have multiple impairments (interacting disabilities, psychosocial problems, and disadvantages) rather than just two illnesses.4,2
  • There are other dual diagnosis populations, such as those with mental illness and developmental disabilities.

Nevertheless, the term dual diagnosis is a standard usage.2


Dual diagnosis is associated with a variety of negative outcomes, including:

  • higher rates of relapse 4
  • hospitalization7 and re-hospitalization2
  • violence and disruptive behavior and violence2, 8
  • incarceration 9
  • homelessness 10
  • serious infections such as HIV and hepatitis 11
  • familial problems2
  • decreased functional status2
  • medication noncompliance2


Experts have written, in effect, that dual diagnosis is an expectation, not an exception

It is now estimated that 60 to 90 percent of people seeking treatment at a mental health facility or a substance abuse facility facilities have dual disorders1

Whereas, another study has established that (about) 50 percent of individuals with severe mental disorders are affected by substance abuse 5


One of the major difficulties in treating dual diagnosis is in engaging the patient in treatment. 13

  • SEPARATE SERVICES V/S INTEGRATED TREATMENT PROGRAMS: Current research also indicates that traditional, separate services for persons with dual disorders are ineffective and that integrated treatment programs that combine mental health and substance abuse interventions offer promise. 2,3
  • INTEGRATED TREATMENT: it means that the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance abuse interventions in a coordinated fashion4.
  • FAMILY INTERVENTIONS: address understanding and learning to cope with two inter-acting illnesses4.
  • MOTIVATIONAL INTERVENTIONS: involve helping the individual identify his or her own goals. They need to develop skills and supports to control symptoms and to pursue an abstinent lifestyle4.
  • COUNSELING: Effective programs provide some form of counseling that promotes cognitive and behavioral skills at this stage. 4


  1. PSYCHIATRIC SERVICES ? September 2000 Vol. 51 No. 9
  2. Robert E. Drake, M.D., Ph.D, Michael A. Wallach, Ph.D; DUAL DIAGNOSIS: 15 YEARS OF PROGRESS; PSYCHIATRIC SERVICES ? September 2000 Vol. 51 No. 9
  3. Drake RE, Mercer-McFadden C, Mueser KT, et al: Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin 24:589?608, 1998
  4. Robert E. Drake, M.D., Ph.D., Susan M. Essock, Ph.D., Andrew Shaner, M.D., Kate B. Carey, Ph.D., Kenneth Minkoff, M.D., Lenore Kola, Ph.D., David Lynde, M.S.W., Fred C. Osher, M.D., Robin E. Clark, Ph.D, Lawrence Rickards, Ph.D.; Implementing Dual Diagnosis Services for Clients With Severe Mental Illness ; PSYCHIATRIC SERVICES; April 2001 Vol. 52 No. 4
  5. Regier DA, Farmer ME, Rae DS, et al: Co-morbidity of mental disorders with alcohol and other drug abuse. JAMA 264:2511?2518, 1990
  1. Swofford C, Kasckow J, Scheller-Gilkey G,et al: Substance use: a powerful predictor of relapse in schizophrenia. Schizophrenia Research 20:145?151, 1996
  2. Haywood TW, Kravitz HM, Grossman LS, et al: Predicting the ?revolving door? phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. American Journal of Psychiatry 152:856?861, 1995


  1. Cuffel B, Shumway M, Chouljian T: A longitudinal study of substance use and community violence in schizophrenia. Journal of Nervous and Mental Disease 182:704?708, 1994
  2. Abram KM, Teplin LA: Co-occurring disorders among mentally ill jail detainees: implications for public policy. American Psychologist 46:1036?1045, 1991
  3. Caton CLM, Shrout PE, Eagle PF, et al: Risk factors for homelessness among schizophrenic men: a case-control study. American Journal of Public Health 84:265?270,1994
  4. Rosenberg SD, Goodman LA, Osher FC, et al: Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health 91:31?37, 2001
    1. Ridgely MS, Osher FC, Goldman HH, et al: Executive Summary: Chronic Mentally Ill Young Adults With Substance Abuse Problems: A Review of Research, Treatment, and Training Issues. Baltimore, University of Maryland School of Medicine, Mental Health Services Research Center,1987
    2. Mueser KT, Bellack AS, Blanchard JJ: Comorbidity of schizophrenia and substance abuse: implications for treatment. Journal of Consulting and Clinical Psychology 60:845?856, 1992