Dual diagnoses

Dual diagnoses is a term used to describe patients with coexisting mental illness and substance abuse disorders. The mental illness must meet criteria for diagnosis by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Unfortunately dual diagnosis is not uncommon, with about half of the people with a diagnosis of severe mental illness and a third of the people with mental illness having problems with substance abuse. The prognosis is worse for patients with mental illness who abuse drugs and/or alcohol.

Psychiatric treatment is more successful with patients who are not actively using. For this reason, the first step is often for the patient to stop using, or if addicted, to detox the patient. Additional treatment may include individual counseling, support groups, and medications to help the patient to develop coping skills, build self-confidence and manage the symptoms of mental illness.

Patients with dual diagnoses are often a challenge for Case Managers.  They are less likely to follow through with their treatment plan by missing appointments and being non-compliant with medications. The Case Manager will be more successful if they can assist the patient to find the motivation to comply with the treatment plan.