DUAL DIAGNOSIS

Dual Diagnosis and Human Services

Dual Diagnosis and Human Services

Dual Diagnosis

Dual diagnosis/co-morbidity are terms used to refer to the condition of people with more than one mental disorder (for instance, depression and personality disorder) and/or those who have mental disorder(s) and are using alcohol or street drugs. Dual diagnosis - the co-incidence of more than one type of mental disorder or of a mental disorder with misuse of drugs or alcohol - is not a single clinical condition, but may be implicated in a wide range of needs and behaviors. An assessment of co-morbidity should enable individuals to have access to appropriate services to meet their complex needs, but in practice, it can become the occasion for rejection, with busy mental health services suggesting initial referral to drug services and vice versa (Evans, 2001).

People who are mentally disturbed is at least as likely as anyone else to misuse substances - and often more so. For instance, people with anti-social personality disorder are significantly more likely than average to drink too much and the combination of anti-social personality disorder and use of alcohol is associated with a high risk of harm to others (Evans, 2001). (Alcohol can depress inhibitions - internal restraints on behavior - which are weaker in people with this disorder.)

While there is debate about the extent to which substance use causes mental disturbance, misuse of certain substances can produce signs of mental illness and, equally, mental distress can lead to substance misuse - for example, through self-medication. Conjecture about causal priority is unlikely to be profitable (Rassool, 2002). Neither problem can be understood without an appreciation of the other: it is precisely the interaction that exacerbates the distress and the risk. The implication is that therapeutic intervention should address both the substance misuse and the mental disturbance in a complementary multidisciplinary endeavor.

Probation officers are likely to encounter many offenders whose behavior is influenced by mental distress in combination with misuse of drink or drugs. This can pose notorious problems for referral. Specialists typically deal with specific disorders and may prefer to place elsewhere the responsibility for dealing with other conditions. People who span diagnostic categories are accordingly always likely to cause difficulties of referral. Under the pressure of resources, this can lead to a disowning, a refusal to accept the referral. Dual diagnosis services are therefore becoming increasingly common, but they, too, have to manage their resources and ...