"Dual Diagnosis Literature, Articles, Chapters and Abstracts"
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Excerpts:

"Dual diagnosis refers to the co-occurence of mental health disorders
and substance abuse disorders (alcohol and/or drug dependence or abuse).
Dual Diagnosis, and Dual/Multiple disorders profiles may include the
following:

1. Severe/major mental illness and a substance disorder(s)

2. Substance disorder(s) and a personality disorder(s)

3. Substance disorder(s), personality disorder(s) and substance induced
acute symptoms that may require psychiatric care, i.e., hallucinations,
depression, and other symptoms resulting from substance abuse or
withdrawal.

4. Substance abuse, mental illness, and organic syndromes in various
combinations. Organic sydromes may be a result of substance abuse, or
independent of substance abuse.

5. Persons are found across the mental health and substance abuse
systems who have various combinations of these dual/multiple disorders.

6. They are also found outside of these systems of care, often among the
homeless, and within the criminal justice system.

7. Acronyms that define various dual disorders:
MICAA: Mentally Ill, Chemical Abusers, and Addicted. Denotes the
severely mentally ill chemical abuser. (Sciacca, 1991)

8. MISA: Mentally Ill Substance Abuser. May denote various combinations
of dual disorders with or without severe mental illness.

9. MIDAA*, This denotes the inclusion of Mental Illness, Drug Addiction
and Alcoholism in various combinations as dual/multiple disorders.

10. CAMI: Chemical Abusing Mentally Ill. This denotes Chemical abuse or
dependence as primary with personality disorders (but without severe
mental illness). (Sciacca,1991).

11. CAMI, With substance induced psychotic episodes: Same as CAMI with
induced acute symptoms. (Sciacca,1991)

Reference: Sciacca, K. "An Integrated Treatment Approach for Severely
Mentally Ill Individuals with Substance Disorders" New Directions for
Mental Health Services, Jossey Bass Publ. Summer 1991,#50.

"traditional addiction treatment emphasizes the concept of "hitting
bottom" as a necessary prerequisite to sobriety (that is, patients must
experience severe losses or deterioration in order to perceive that they
need help for addiction). For MICAA patients, however, "hitting bottom"
can mean decompensation into severe psychosis and regression in all
areas of functioning. This is not recommended. Sciacca (1987b) has
advocated that MICAA clients be maintained at a stable level, and that
progress in substance abuse treatment should proceed from that level."

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"The Family and the Dually Diagnosed Patient"


Excerpt:

"A growing awareness of the problems and some solutions to the provision
of treatment of persons who are dually diagnosed is under way. Much has
been written about the problems of substance abuse among mentally ill
patients. These patients have been characterized as systems misfits with
poor outcome, more relapses, more acting out behavior, and more
likelihood of being homeless (Minkoff and Drake,1991). Dually diagnosed
patients experience interaction effects that compound their distress and
disability (Evans and Sullivan 1991). These patients tend to respond to
their distress by exhibiting highly disturbing acting-out behaviors
(McCarrick, Manderschied, et.al. 1985)

Despite these serious consequences, the family movement has not attained
the degree of knowledge about addictive disorders as they have about
mental illness. There is a need for education that demonstrates that
addictive disorders are illnesses. Understanding mental illness as a
disease that is not caused by families was necessary to successful
advocacy for the mentally ill. The same advocacy must happen for those
who are dually diagnosed, through a clear understanding of the addictive
disorders. Families of the dually diagnosed continue to experience
frustration resulting from a service delivery system that does not meet
their needs, or the needs of their relatives.

ISSUES THAT IMPEDE SERVICES FOR THE DUALLY DIAGNOSED AND FAMILIES.

Both families and providers encounter difficulty in accessing
comprehensive services for the dually diagnosed. The underlying issues
are the same nationally. They include: 1. Divided bureaucracies across
discrete disorders, mental illness, drug addiction and alcoholism and
segregated admissions criteria, treatment programs, services, and
reimbursement; 2. Providers are educated and trained to deliver services
for singular disorders, and are not prepared to provide services for
unfamiliar symptoms (Ridgely, Goldman,& Willenbring,1990); and, 3.
Treatment approaches across these discrete disorders are different in
method and philosophy and are in direct contrast and incompatible
(Sciacca,1991).

Traditional treatment methods for drug addiction and alcoholism are
usually intense and confrontational. They are designed to break down the
patient's denial or resistance of his or her addictive disorder.
Admissions criteria to substance abuse programs usually require
abstinence from all illicit substances. Potential patients are expected
to be aware of the problems caused by substance abuse, and motivated to
receive treatment. In some programs the use of medication unacceptable.
This automatically excludes people who take prescribed medication for
their symptoms of mental illness. In contrast, treatment methods used
for serious mental illness are supportive, benign and non-threatening.
They are designed to maintain the patient's defenses which are often
fragile to begin with.

These differences perpetuate the gaps in services and eliminate the
dually diagnosed from existing services. The traditional substance abuse
services will not accept patients who have a serious mental illness
either because they do not meet the readiness criteria, or because they
are not prepared to provide services for symptoms of mental illness. If
accepted into a substance abuse program that is not modified, the dually
diagnosed patient may experience difficulty when participating in an
intense, confrontational program."

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