Dual Diagnosis

“Dual diagnosis” is used to describe patients with severe mental illness (mainly psychotic disorders) and co-existing problematic drug and/or alcohol use. The term originated from the US in the 1980s and has been adopted in the UK more recently. The nature of the relation between the two conditions is complex and sometimes controversial although the following list outlines current accepted thinking:

� A primary psychiatric illness may precipitate or lead to substance misuse.
� Substance misuse may worsen or alter the path of a psychiatric illness.
� Intoxication and/or substance dependence may lead to psychological symptoms.
� Substance misuse and/or withdrawal may lead to psychiatric symptoms or illness.

Personality disorders are seen as a separate dimension which may co-exist with psychiatric illness and/or substance misuse.

Prevalence of Dual Diagnosis

In the UK, it is thought that the number of people with a potential “dual diagnosis” is high and possibly rising.

� About a third to a half of those with severe mental health problems will also have substance misuse problems.
� Alcohol misuse is the most common type of substance misuse and where drug misuse occurs, it tends also to co-exist with alcohol misuse.

Many Community Mental Health Trusts in the UK typically report 8-15% of their clients have dual diagnosis problems but rates are higher in inner cities. One survey showed that 36% of clients seen by an inner London psychiatric service were dependent on alcohol and/or drugs. Substance misuse is usual rather than exceptional amongst those with severe mental health problems.

Symptoms of Dual Diagnosis

Substance-induced psychotic symptoms resulting from substance misuse include:

� Cannabis intoxication can induce a transient, self limiting psychotic disorder characterised by hallucinations and agitation.
� Psycho stimulants such as amphetamines when used over prolonged periods can produce a psychotic picture similar to schizophrenia.
� Hallucinogen-induced psychosis is usually transient but can persist with sustained use.
� Heavy alcohol use is associated with morbid jealousy and alcoholic hallucinations. Withdrawal from alcohol may also provoke psychotic symptoms.

Treatment of Dual Diagnosis

� There has been a tendency in the past to find appropriate referral difficult as those with dual diagnosis may “fall between the two stools” of psychiatric services and drug and alcohol agencies but the need for better coordination and clearer care pathways is strongly advocated.
� Whilst the evidence base for integrated programmes for the treatment of both substance misuse and severe mental illness is limited research is on-going to decide what the best clinical practices are and how best to provide services.
� To be effective it is believed that treatment should be staged according to an individual’s readiness for change and engagement.

Complications of Dual Diagnosis

Dual diagnosis is associated with:

� Worsening psychiatric symptoms
� More frequent re-hospitalisation
� Poor medicine adherence
� Homelessness
� Increased risk of HIV infection
� Poor social outcome (including impact on family and carers)
� Increased risk of violence and contact with the Criminal Justice system
� Increased risk of suicide.

treatment-now.com have access to extremely high quality treatment provision (invariably Residential Rehab clinics or Psychiatric Hospitals) with the expertise to manage and treat patients with identified Dual Diagnosis problems.

Call 0207 100 9931 for more information and, if necessary an urgent Psychiatric assessment and admission into treatment.