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Co-existing Problems of Mental Health and Substance Misuse (Dual Diagnosis): A Literature Review

NCJ Number
Drugs: Education, Prevention, and Policy Volume: 10 Dated: 2003 Pages: S1-S74
Vanessa Crawford; Ilana B. Crome; Carmel Clancy
Date Published
75 pages
This document discusses literature relating to substance use and psychiatric disorders.
This review provides an overview of the literature between January 1990 and February 2001. The concept of dual diagnosis or co-morbidity of substance use and psychiatric disorders has gained prominence in the last two decades. This is due to the closure of the large psychiatric hospitals and the increasing prevalence of drug use in the community. Two hundred papers were selected from 1,100 abstracts. Articles were chosen on the basis that they were original research, had sufficient subjects in the study to be meaningful, and appeared to be relevant to the United Kingdom. The focus of this study was the adult population. A thorough and dynamic assessment, including a full history, underpins treatment of co-morbidity. The more comprehensive and focused the assessment the better the understanding will be of the relationship between the two disorders. Substance-specific research includes nicotine, alcohol, cannabis, benzodiazepines, heroin, and cocaine. The specific co-morbid psychiatric conditions discussed are bipolar affective disorder, schizophrenia, personality disorders, and post-traumatic stress disorder. Childhood, women, violence, and suicide are recurrent themes in the literature and each has a section dedicated to giving a better understanding of some of the pathways and risk factors that may impact on the future development of dual diagnosis. The types of treatment, such as assertive community treatment and psychological interventions, are reviewed for the adult co-morbid population. The pattern of substance use in the community is constantly changing. Dual-diagnosis populations are heterogeneous, so there are many combinations of substance use and mental illness to be the subject of research studies. Mental health policymakers equally need to be aware that the population being seen by mental health services is different in terms of co-morbidity now compared to 10 years ago. This needs to be reflected in future strategies. 138 references, 2 appendices