Dual diagnosis and integrated care

Meet the patient

A 24-year-old with schizophrenia is discharged from the psychiatric ward on Tuesday. He is referred to the drug service, who write back that he is "too unwell for our programme". He is referred back to mental health, who write that he is "primarily a substance issue".[4][6]

He smokes high-potency cannabis every night, has stopped his antipsychotic, and has been sleeping at his cousin's since February. He does not want to stop smoking. He does want to stop hearing the voices.[14][15]

Nobody has done anything wrong on either side of that correspondence, and he is still untreated by both. The examinable question is not which diagnosis is primary — it is why he is standing between two buildings.[6][17]

References20Show ledgerHide ledger

1. [1]Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study JAMA, 1990.PMID 2232018
2. [2]Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Arch Gen Psychiatry, 2005.PMID 15939839
3. [3]Mueser KT, Drake RE, Wallach MA Dual diagnosis: a review of etiological theories Addict Behav, 1998.PMID 9801712
4. [4]Drake RE, Mercer-McFadden C, Mueser KT, et al. Review of integrated mental health and substance abuse treatment for patients with dual disorders Schizophr Bull, 1998.PMID 9853791
5. [5]Minkoff K An integrated treatment model for dual diagnosis of psychosis and addiction Hosp Community Psychiatry, 1989.PMID 2807203
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10. [10]Prochaska JO, DiClemente CC Stages and processes of self-change of smoking: toward an integrative model of change J Consult Clin Psychol, 1983.PMID 6863699
11. [11]Hettema J, Steele J, Miller WR Motivational interviewing Annu Rev Clin Psychol, 2005.PMID 17716083
12. [12]Lundahl B, Moleni T, Burke BL, et al. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials Patient Educ Couns, 2013.PMID 24001658
13. [13]Brunette MF, Mueser KT Psychosocial interventions for the long-term management of patients with severe mental illness and co-occurring substance use disorder J Clin Psychiatry, 2006.PMID 16961419
14. [14]Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study Lancet Psychiatry, 2019.PMID 30902669
15. [15]Schoeler T, Petros N, Di Forti M, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study Lancet Psychiatry, 2016.PMID 27567467
16. [16]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
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19. [19]Eddie D, Hoffman L, Vilsaint C, et al. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching Front Psychol, 2019.PMID 31263434
20. [20]Saitz R Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking Drug Alcohol Rev, 2010.PMID 20973848