Dual Diagnosis

The traditional view that psychiatric disorders are unrelated to alcohol and other drug (AOD)-use problems has hampered effective treatment of patients who exhibit both types of disorder Psychiatric and AOD disorders produce many similar symptoms and often coexist in the same patient, where one disorder can influence the course and treatment outcome of the other. The existence of two or more different disorders in the same patient is referred to as comorbidity. Patients with comorbid AOD and psychiatric disorders are said to have dual disorders, or a dual diagnosis.

Patients with dual disorders may be misdiagnosed and improperly treated, often “falling through the cracks” in the health care system. For example, alcoholics with psychiatric disorders may be rejected by both alcoholism programs and mental health programs. This article explores some problems in diagnosing and treating alcoholics with dual diagnoses.

How Common Is Dual Diagnosis

Two large epidemiologic studies have provided data on the prevalence of dual diagnosis in the general population. The Epidemiologic Catchment Area (ECA) study sought data on psychiatric disorders and their treatment from more than 20,000 residents of households, group homes, and long-term institutions in five sites across the United States. The ECA found that 13.5 percent of respondents had experienced an alcohol-use disorder at some time in their lives, 6.1 percent had experienced other drug-use disorders, and 22.5 percent had experienced non-AOD psychiatric disorders. Lifetime prevalence for any psychiatric or AOD disorder was 34 percent. Overall, the lifetime prevalence for any psychiatric disorder was 44 percent among people with an alcohol disorder and 64.4 percent among people with other drug-use disorders

Effective treatment of dual disorders begins with a thorough diagnostic assessment. The frequent occurrence of psychiatric or addictive symptoms in the absence of an independent disorder, as discussed previously, suggests the importance of distinguishing between drinking and alcoholism; sadness and depression; and anxiety feelings and major anxiety disorders. Many mistakes can be avoided by the careful use of appropriate diagnostic criteria.

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Regards,
Nancy Ella