Back

Dual Diagnosis

WHAT CAUSES ADDICTION?

Dual Diagnosis Defined

Dual diagnosis is the term used to describe individuals who have two or more psychological disorders. For the purposes of this web page, dual diagnosis refers to the presence of a substance use disorder (SUD) in combination with either a:

  • Mental disorder
  • Personality disorder
  • Cognitive or physical disability
  • Serious life problem (i.e. unresolved grief over the loss of a loved one)

 

A Substance use disorder can be either:

  • An abuse disorder
  • A dependence disorder (addiction)
  • A substance induced disorder (see below)

Back to Top

Other Terminology for Dual Diagnosis

Other terms for dual diagnosis include: addiction & co-occurring disorders (ACD), chemically abusing mentally ill (CAMI), co-occurring addictive & mental disorders (COAMD), co-occurring disorders, dual disorders, mentally ill chemically addicted (MICA), mentally ill substance abuser (MISA), and substance abusing mentally ill (SAMI),

The terms “dual diagnosis” and “dual disorders” remain popular terms. The popularity of these terms may be due, in part, to the early use of these terms that preceded currently preferred terms such as “co-occurring” or “co-existing” disorders. Another explanation for the continued use of the term may be simply due to the fact that it is shorter and easier to say.

Critics of these terms point out that there are usually multiple disorders, disabilities, or psychosocial problems. 

Source: Dual Diagnosis: 15 Years of Progress (2000) Robert E. Drake & Michael A. Wallach

Back to Top

Most Common Co-Occurring Disorders

The most common co-occurring disorders among adolescents include:

  1. conduct disorders
  2. attention deficit hyperactivity disorders (ADHD)
  3. major depressive disorder
  4. generalized anxiety disorder
  5. post-traumatic stress disorder (PTSD)

 

While the most common co-occurring disorders among adults include:

  1. substance use disorder (abuse or dependence)
  2. substance-induced organic mental disorders (transient neuropsychological impairment and post acute withdrawal (PAW))
  3. depression (non-trauma related)
  4. trauma spectrum disorders

Back to Top

Why It’s Important to Know about Dual Diagnosis

Understanding dual diagnosis is important because (1) it’s common, (2) frequently misdiagnosed, and related to (3) reluctance to seek treatment, (4) lower retention rates (treatment completion) and (5) and lower incidence of positive treatment outcomes (high relapse rates).

Individuals afflicted with dual diagnosis place a huge demand on the following services:

  • Primary health care – individuals with co-occurring substance use disorders and mental disorders have high rates of other health problems and often seek help in primary treatment settings such as hospitals and medical clinics. Unfortunately, primary care physicians often fail to detect the presence of these disorders ¹
  • Homeless services – approximately 39 percent of people who are homeless have a mental disorder, and an estimated 50 percent of adults with serious mental illness who are homeless also have a substance use disorder ²
  • Criminal Justice System – studies show the use of drugs or alcohol by people with untreated mental illness increases the potential for violent behaviours ³. The result is that many individuals who don’t get treatment for their dual diagnosis end up behind bars.

 

(1) Source: Ford, D.E. (1994). Recognition and under-recognition of mental disorders in adult primary care. In Miranda, J., Hohmann, A.A., Attkisson, C.C., et al. (Eds.). Mental disorders in primary care. San Francisco, CA: Jossey-Bass.

(2) Source: U. S. Department of Health and Human Services. (1999) Mental health: A report of the Surgeon General. U. S. Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

(3) Source: Institute of Medicine (1999) The role of co-occurring substance abuse and mental illness in violence: Workshop summary. Washington, DC: IOM, Division of Neuroscience and Behavioral Health.

Back to Top

Mental Illness and Substance Use Disorders are often Inter-Related

Research has shown that mental health disorders and substance use disorders are inter-related. For example, the National Comorbidity Study (NCS) ¹ administered in the US between 1990 and 1992 showed that:

  • 42.7 percent of individuals with a 12-month addictive disorder had at least one 12-month mental disorder
  • 14.7 percent of individuals with a 12-month mental disorder had at least one 12-month addictive disorder

An earlier study, the Epidemiologic Catchment Area (ECA) Survey ² administered between 1980 and 1984 found that:

  • 47 percent of individuals with schizophrenia also had a substance abuse disorder (more than four times as likely as the general population)
  • 61 percent of individuals with bi-polar disorder also had a substance abuse disorder (more than five times as likely as the general population).

The results confirm the increased risk for people with either a substance abuse disorder or mental disorder for developing a co-occurring disorder.
(1) Source: Kessler, R.C., Nelson, C.B., McGonagle, K.A., et al. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry 66 (1): 17-31.
(2) Source: Regier, D., Farmer, M., Rea, D., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the epidemiologic catchment area study. Journal of the American Medical Association 264: 2511-2518.

Back to Top

Substance Induced Disorders Explained

Individuals who are actively using drugs or alcohol may appear to have mental illnesses such as:

  1. anxiety
  2. depression
  3. psychotic disorders
  4. personality disorders

 

These mental disorders may disappear over time (clinically called the “resolution period”) once the body has had time to repair itself from the toxic effects of drugs and/or alcohol.  Typically, 30 days is enough time to determine whether the persistence of symptoms/impairment is sufficient for a psychiatric diagnosis. However, heavy use of certain drugs can extend the resolution period to 90 days.

If you suspect an individual is suffering from substance induced disorder you may want to consider residential treatment that is longer than 30 days in length with a comprehensive mental health assessment provided at the beginning and end of treatment.

For an excellent table showing resolution periods see page 35 and 36 of the Behavioral Health Recovery Management Service Planning Guidelines for Co-Occurring Psychiatric and Substance Disorders Manual.

Back to Top

Dual Diagnosis can Increase the Risk of Suicide

Statistics show that 15% to 25% of suicides are committed by individuals who abuse alcohol. Psychotic episodes resulting in suicide may be associated with intoxification, withdrawal, or chronic substance abuse.

Source: RachBeisel, J., & McDuff, D. (1995). Mental disorders secondary to chronic substance abuse. In Lehman, A.F., & Dixon, L.B. (Eds.). Double jeopardy: Chronic mental illness and substance abuse disorders. Binghamton, NY: Harwood Academic Publishers.

Screening and Assessment for Dual Diagnosis

Visit the Winnipeg Region Co-Occurring Disorders Initiative for some useful web links for locating co-occurring disorder screening and assessment tools.

The Mental Health Screening Form III includes the test and guidelines section for clinicians.

Back to Top

Basic Principles for the Treatment of Dual Diagnosis

Terence T. Gorski identifies the following basic principles for the treatment of dual disorders:

  1. Dual disorders are co-existing, inter-related, and need to be treated at the same time
  2. untreated dual disorders increase relapse rates
  3. dual disorders must be identified before they can be treated
  4. effective treatment requires a comprehensive systems approach

 

Individuals with dual diagnosis need to be simultaneously detoxified and psychiatrically stabilized. Only then, after the client is abstinent, can an accurate diagnosis be established, and a treatment plan to treat both disorders be simultaneously developed. An assessment that is not comprehensive, that looks only at either substance abuse or mental illness will leave a client vulnerable to relapse due to the untreated disorder.

Source: Terence T. Gorski.

Back to Top

RESOURCES

I. PRINTED RESOURCES ON DUAL DIAGNOSIS (CO-OCCURRING DISORDERS)

Printed Resources – General Reading on Dual Diagnosis

Recommended Reading for Clinicians

Integrated Treatment for Dual Disorders: A Guide to Effective Practice  (2003) Kim T. Mueser, Douglas L. Noordsy, Robert E. Drake, and Lindy Fox 

Celebrating Small Victories: A Counselor’s Manual for Treating Chronic Mental Illness and Substance Abuse (1995) Kenneth A. Montrose and Dennis Daley

Community Care for Homeless Clients with Mental Illness, Substance Abuse, or Dual Diagnosis (1994) Ellen L. Bassuk (Paperback – 1994)

Contemporary Dual Diagnosis: MH/MR Service Models Volume II: Partial and Suportive Services (Monograh series) (2002) John W. Jacobson, Steve Holburn, James A. Mulick, and Robert J. Fletcher

Co-occurring Substance Abuse and Mental Disorders: A Practitioner’s Guide (2007) John Smith

Designing, Implementing, and Managing Treatment Services for Individuals with Co-Occurring Mental Health and Substance Use Disorders: Blueprints for Action (2006) Edward L. Hendrickson

Dual Diagnosis (Key Readings in Addiction Psychiatry, 2) (2003) R Rosenthal

Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd Ed.) (2000) articulates a framework for assessment and treatment and a range of counseling and motivational strategies for adolescents and adults. Katie Evans, J. Michael Sullivan

Dual Diagnosis: Evaluation, Treatment, Training, and Program Development(1993) Joel Solomon, Sheldon Zimberg, and Edward Shollar 

Dual Diagnosis: The Evolving Conceptual Framework (Bibliotheca Psychiatrica) (2005) R. Stohler and Wulf Rossler

Dual Diagnosis: Filling the Gap (2003) Giuseppe (ed) Carra

Dual Diagnosis: An Integrated Approach to Treatment (2000) Ted R. Watkins, Ara Lewellen, and Marjie C. Barrett

Dual Diagnosis of Major Mental Illness and Substance Abuse: Recent Research and Clinical Implications (New Directions for Youth Development) (1996) Robert E. Drake

Dual Disorders: Nosology, Diagnosis and Treatment Confusion- Chicken or Egg (Journal of Addictive Diseases) (2008) Mark S. Gold

Dual Diagnosis Nursing (2006) Mohammed Abuel-Ealeh, Richard Barrett, Keith Barry, and Richard Bryant-Jefferies

Dual Diagnosis and Psychiatric Treatment: Substance Abuse and Comorbid Disorders, Second Edition (Medical Psychiatry, 27) (2004) Henry R. Kranzler and Joyce A. Tinsley

The Dual Diagnosis Recovery Sourcebook: A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder (2001) Dennis Ortman

Dual Diagnosis: Schizophrenia and Other Psychotic Disorders and Developmental Disabilities Manual (2003) Kathleen M., Ph.D. Olson, Jessica A. Hellings, and Patricia A. Black

Dual Diagnosis in Substance Abuse (1991) Mark S. Gold and Andrew E. Slaby

Dual Diagnosis: Substance Misuse and Psychiatric Disorders (2002) will provide practitioners with a comprehensive text on the contemporary issues of working with dual diagnosis patients from both clinical and theoretical perspectives. G. Hussein Rassool

Dual Diagnosis and Treatment : Substance Abuse & Comorbid Medical & Psychiatric Disorders (Medical Psychiatry, Vol 8) (1998) Henry R. Kranzler and Bruce J. Rounsaville

Dual Diagnosis Workbook (2000) Dennis C. Daley

Dual Disorders : Counseling Clients With Chemical Dependency and Mental Illness (2002) Dennis Daley and M.D., Howard B. Moss

Guide to Self-Help Workbooks for Mental Health Clinicians and Researchers (2004) Luciano L’Abate

Integrated Treatment for Dual Disorders: A Guide to Effective Practice (2003) is a guide for health and medical practitioners that discusses treatment of patients with both psychiatric disorders and substance abuse problems.  Kim Tornvall Meuser, Douglas L. Noordsy, Robert E. Drake, Lindy Fox.

Masquerade: Unmasking Dual Diagnosis (2004) Richard A. Morin

New Directions for Mental Health Services, Dual Diagnosis of Major Mental Illness and Substance Disorder, No. 50 (J-B MHS Single Issue Mental Health Services) (1991) Kenneth Minkoff and Robert E. Drake

Readings in Dual Diagnosis by International Association of Psychosocial Rehabilitation Services (1997) Robert E. Drake

Back to Top

Printed Resources – Adolescents and Dual Diagnosis

Relationship Between Mental Health and Substance Abuse Among Adolescents(1999) presents an examination of the association between psychological functioning & substance use among adolescents aged 12 to 17. Dena R. Gerstein, Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).

Youth & Drugs and Mental Health: A Resource for Professionals (2004) Centre for Addiction and Mental Health (CAMH).

For more information on adolescents see the Help for Parents & Teens section.

Printed Resources – Attention Deficit Disorder and Dual Diagnosis

The Link Between ADD & Addiction: Getting the Help You Deserve
(1997) examines the relationship between ADD and addictive behavior and offers insight and help for people with ADD, who are also struggling with an addiction. The text provides self-tests and checklists to help identify both ADD and addiction, as well as offering practical solutions for recovery. Wendy Richardson

When Too Much Isn’t Enough: Ending the Destructive Cycle of AD/HD and Addictive Behavior (2005) Wendy Richardson
 

Back to Top

Printed Resources – Borderline Personality and Dual Diagnosis

Understanding Borderline Personality Disorder and Addiction Workbook (Co-Occurring Disorders) (2004) Juergen E. Korbanka 

Printed Resources – Chronic Pain and Dual Diagnosis

Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management System (1999) Dr. Stephen F. Grinstead

Pain and Its Relief Without Addiction: Clinical Issues in the Use of Opioids and Other Analgesics(1997) will help people in pain understand why their pain is not always adequately relieved, as well as help reverse the failure of current medical practice to routinely alleviate pain. Barry Stimmel.

Printed Resources – Depression and Dual Diagnosis

The mental status of 1090 heroin addicts at entry into treatment: should depression be considered a ‘dual diagnosis’? (November 2007) concludes that the presence of depressive-anxious symptomatology in the clinical presentation in heroin addicts appears to be unrelated to ‘dual diagnosis.’ Annals of General Psychiatry.

Printed Resources – Drug Policy and Dual Diagnosis

Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders (2002)

For more information on drug policy see the Drug Policy section.

Back to Top

Printed Resources – Medical Treatment and Dual Diagnosis

Dual Diagnosis Nursing: Nursing Care and Management (2006) addresses key issues such as needs of special populations, multi-dimensional assessment, dealing with emergencies, prescribing and medication management, nursing and psychological interventions, spiritual needs, carers’ interventions and professional development. G. Hussein Rassool.

Printed Resources – Physical Disabilities and Dual Diagnosis

Substance Use Disorder Treatment for People with Physical and Cognitive Disabilities(1998) focuses on the needs of adults in treatment who have a coexisting physical or cognitive disability. Dennis Moore, Treatment Improvement Protocol (TIP) Series 29. DHS Publication (SMA 98-3249.

Printed Resources – Relapse Prevention and Dual Diagnosis

Preventing relapse (Co-occurring disorders series) (2003) Dennis C Daley 

For more information on relapse see the Relapse Prevention Facts section.

Printed Resources – Research on Dual Diagnosis

Dr. Kenneth Minkoff has a reference bibliography on the topic of dual diagnosis.

For more information on addiction research see the Addiction Research section.

Printed Resources – Schizophrenia and Dual Diagnosis

Tobacco Dependence Amongst Individuals with Schizophrenia: A Public Health Crisis and an Opportunity for Research (November 2007) Douglas M Ziedonis, Ivan D. Montoya

Integrated Treatment for Dual Disorders: A Guide to Effective Practice  (2003) Kim T. Mueser, Douglas L. Noordsy, Robert E. Drake, and Lindy Fox 

Overcoming Addictions: Skills Training for People With Schizophrenia (1999) Roberts LJ, Shaner A, & Eckman TA

Back to Top

Printed Resources – Self-Help Books on Dual Diagnosis

At Wit’s End: What You Need to Know When a Loved One Is Diagnosed with Addiction and Mental Illness (2007) Jeff Jay and Jerry Boriskin

The Dual Diagnosis Primer: A Training Manual for Family Members, Case Managers, Advocates, Guardians, and Direct Support Professionals (2006) Edward E. Hughes

The Dual Diagnosis Recovery Sourcebook: A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder (2001) Dennis Ortman

The Dual Disorders Recovery Book (1993) Anonymous

The Twelve Steps and Dual Disorders: A Framework of Recovery for Those of Us With Addiction & an Emotional or Psychiatric Illness (1994) Pat Samples and Tim Hamilton

Working the 12 Steps (Co-Occurring Disorders) (1990) Hazelden

Printed Resources – Suicide and Dual Diagnosis

Understanding Suicide and Addiction (Co-occurring disorders series) (2003) Dennis C Daley

Printed Resources – Testimonials and Dual Diagnosis

The Eden Express: A Memoir of Schizophrenia (2002) Mark Vonnegut

Printed Resources – Trauma and Dual Diagnosis

Military Veterans PTSD Reference Manual (March 2008) Bob Parrish

Psychological Trauma and Addiction Treatment (2006) is an overview of trauma treatment for people in addiction treatment settings. Prsents specific methodologies and techniques for clients in inpatient and outpatient addiction/mental health settings. Bruce Carruth

Ptsd And Addiction: A Practical Guide For Clinicians And Counselors(2004) provides clinicians an integrated approach to working with clients who suffer from trauma and addiction. Jerry A., Ph.D. Boriskin

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (2001) Lisa M. Najavits

Trauma and Addiction: Ending the Cycle of Pain Through Emotional Literacy (2000) uses a combination of research and client stories to illustrate how we can learn the esteem-building and ego-strengthening skills of emotional literacy. Tian Dayton

Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders  (2003) Paige Ouimette, Pamela J. Brown, American Psychological Association (APA).

Treating Addicted Survivors of Trauma (1995) provides professionals with the tools they need to help adult and adolescent survivors of childhood abuse and other traumas who struggle with addictive disorders. Katie Evans, J. Michael Sullivan.

Understanding Post-traumatic Stress Disorder and Addiction (2003) provides an overview of the symptoms and problems associated with PTSD and addiction, a discussion on the recovery process, and tools for the addicted survivor of trauma. Katie Evans.

Back to Top

Printed Resources – Treatment for Dual Diagnosis

Managing the Dually Diagnosed Patient: Current Issues and Clinical Approaches (2nd Ed.) (2002) delivers current information on the psychiatric problems common with chemically dependent populations – affective disorders, anxiety disorders, personality disorders, and schizophrenia.

Overcoming Addictions: Skills Training for People With Schizophrenia (1999) Roberts LJ, Shaner A, & Eckman TA

Substance Abuse Treatment For Persons With Co-Occurring Disorders (A Treatment Improvement Protocol TIP 42) (2005) SAMHSA – US Department of Health & Human Services

Treating Concurrent Disorders: A Guide for Counsellors (2005) Centre for Addiction and Mental Health (CAMH).

Treating Co-Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals (2004) Edward L. Hendrickson, Marilyn Strauss Schmal, Sharon C. Ekleberry

Printed Resources – Violence and Dual Diagnosis

The Violence and Addiction Equation: Theoretical and Clinical Issues in Substance Abuse and Relationship Violence (2002) bridges the relationship between violence and substance addiction with a focus on the overlap issues. Christine Wekerle, Anne-Marie Wall.

Back to Top

II. ONLINE RESOURCES FOR DUAL DIAGNOSIS (CO-OCCURRING DISORDERS)

Websites Specific to Dual Diagnosis

Behavioral Health Recovery Management is committed to applying the principles of disease management to assist in the treatment of chemical dependency and/or serious mental illness.

Co-Occurring Center for Excellence (COCE) is a national resource for the field of co-occurring mental health and substance use disorders (COD). Funded by SAMHSA, an Agency of the Department of Health and Human Services (US).
COCE has a series of expert presentations on co-occurring disorders (COD). These presentations are grouped according to their target audience.

Mental Illness, Drug Addiction and Alcoholism (MIDAA) is a dual diagnosis resource website developed by Kathleen Sciacca of New York.

Ken Minkoff has a wealth of information on the topic of co-occurring disorders. Dr. Minkoff is recognized as one of North America’s leading experts on integrated treatment of individuals with co-occurring psychiatric and substance disorders.

The National Registry of Evidence-based Programs & Practices (NREPP) is a searchable database of interventions for the prevention and treatment of mental health and substance use disorders. SAMHSA has developed this resource to help people, agencies, and organizations implement programs and practices in their communities.
 
PA-CO-OCCURRING.ORG is a co-occurring resource & information center sponsored by the Department of Public Welfare, Office of Mental Health and Substance Abuse Services (OMHSAS) and the Northeast Addiction Technology Transfer Center (NeATTC), and the Institute for Research, Education and Training in Addictions (IRETA).

Seeking Safety is a content-rich website for information on co-occurring PTSD and substance use disorder. Seeking Safety is a treatment approach developed by Lisa Najavits at Harvard Medical School.

Back to Top

Websites Specific to Dual Diagnosis Self-Help Support Groups

Double Trouble in Recovery
Dual Recovery Anonymous

For more self-help see the Self-Help section.

Websites Specific to Mental Health

Health Canada – Healthy Living – Mental Health
Mood Disorders Canada
National Mental Health Information Center
Public Health Agency of Canada – Mental Health

Online Resources – General Information on Dual Diagnosis

Concurrent Substance Use and Mental Health Disorders: An Information Guide (2004) is for people with concurrent disorders and for their families. It is also for anyone who wants basic information about concurrent disorders, their treatment and their management. Wayne J. Skinner, Centre for Addiction and Mental Health (CAMH). ISBN 0-88868-474-6.Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders (November 2002) outlines the scope of the problem, current treatment approaches, best practice models, and prevention efforts. Substance Abuse and Mental Health Services Administration (SAMHSA).

Summary Report on the Workshop on Best Practices for Concurrent Mental Health and Substance Use Disorders (2002) is the findings of a workshop designed to create “best practices” for (1) screening; (2) assessment; (3) program/system integration; (4) treatment integration; and (5) support services for dual diagnosis patients. Cat. No. H46-2/02-266E. Health Canada.

Back to Top

Online Resources – Adolescents and Dual Diagnosis

First Contact: A Brief Treatment for Young Substance Users with Mental Health Problems(2004) is a brief, first step intervention that focuses on drug use in the context of other mental health problems. It can be implemented in the various settings where youth present – addiction services, social services, etc., – as a first step to more extensive treatment or as a stand-alone intervention. Suitable for youth 14 to 25. Elsbeth Tupker, Centre for Addictions and Mental Health. ISBN 0-88868-476-2.

Overview of Youth Substance Use and Mental Health Problems is Chapter 1 of Youth & Drugs and Mental Health: A Resource for Professionals. Centre for Addiction and Mental Health (CAMH).

For more information on teen addiction see the Help for Parents & Teens section.

Online Resources – Anxiety and Dual Diagnosis

Anxiety Disorders Toolkit: Information and Resources for Effective Self-Management of Anxiety and Anxiety Disorders (October 2003) provides basic facts about anxiety and anxiety disorders. It is designed to help individuals effectively manage the symptoms of anxiety disorders. BC Partners for Mental Health and Addiction Information.

Online Resources – Case Management and Dual Diagnosis

Making the Link: Case Management and Concurrent Disorders (2006) is an Alberta report that presents challenges around building capacity and treatment planning for people with co-existing mental health and addictions. Alberta Alcohol and Drug Abuse Commission (AADAC).

Online Resources – Chronic Pain and Dual Diagnosis

Chronic pain combined with drug or alcohol addiction is also considered dual diagnosis.

Treating People in Chronic Pain (December 2007) Stephen F. Grinstead, Addiction-Free Pain Management.

For more information on treating chronic pain and co-existing disorders (such as addiction) see the Addiction-Free Pain Management website produced by Dr. Stephen F. Grinstead.

Back to Top

Online Resources – Depression and Dual Diagnosis

Depression: Diagnostic Evaluation and Treatment is a fact sheet from the National Institute of Mental Health (NIMH).

Depression-screening.org has a confidential depression screening test. National Mental Health Association.

Depression Toolkit: Information and Resources for Effective Self-Management of Depression (October 2003) contains resources and strategies important for the “self-management” of depression including education, working with a health professional, then sticking with it. BC Partners for Mental Health and Addiction Information.

Study: Depression and alcohol dependence among heavy drinkers (August 2005) examined the relationship between alcohol dependence and depression in a nationally representative sample of men and women who were classified as heavy drinkers. Statistics Canada

Online Resources – Disabilities and Dual Diagnosis

2006-2007 Accessibility Plan (2006) describes the measures that CAMH took to identify, remove, and prevent barriers in accessing the organization’s facilities and services, including patients, staff, clients, and other members of the CAMH community. Centre for Addiction and Mental Health (CAMH).

Online Resources – Homelessness and Dual Diagnosis

Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring Substance Use Disorders offers practical advice for how to plan, organize, and sustain a comprehensive, integrated system of care designed to end homelessness for people with serious mental illnesses and/or co-occurring substance use disorders.Substance Abuse and Mental Health Services Administration (SAMHSA).

For additional addiction resources for the homeless population see the Special Populations section.

Online Resources – Motivational Enhancement and Dual Diagnosis

Motivational Enhancement for Dually Diagnosed Consumers (October 2001) is a guideline to introduce clinicians to the use of Motivational Enhancement Therapy with dually diagnosed consumers as one component of an integrated treatment program. Daniel D. Squires, Theresa B. Moyers, Behavioral Health Recovery Management.

For more information on Motivational Enhancement see the Psychological Modalities section.

Back to Top

Online Resources – Prevention and Dual Diagnosis

Beyond the Label (2005) is an educational kit to promote awareness and understanding of the impact of stigma on people living with concurrent mental health and substance use problems. Centre for Addiction and Mental Health (CAMH).

Drug Info Clearinghouse of Australia provides information on the prevention and early intervention of co-existing mental health and substance use issues.

For more information on prevention see the Addiction Prevention Resources section.

Online Resources – Research and Dual Diagnosis

Best Practices – Concurrent Mental Health and Substance Use Disorders (2002) Health Canada. Cat. No. H39-599/2001-2E

Male Admissions with Co-occurring Psychiatric and Substance Use Disorders: 2005 (December 2007) shows evidence that the incidence and outcomes of dual diagnosis differs between male and females. Drug and Alcohol Services Information System (DASIS).

Mental Illness and Addiction in Canada (May 2006) provides statistics on vulnerable groups (children, women, seniors, offenders, aboriginals, etc.) Also provides statistics on mental illness in the workplace, suicide, hospitalization, etc. Mood Disorders Society of Canada.

Models of Service for Persons with Co-occurring Mental Health and Substance Use Disorders (April 2001) is a literature review on how mental health and addiction services can best be organized and delivered to meet the needs of persons with combined mental health and substance abuse disorders. Winnipeg Regional Health Authority, Addictions Foundation of Manitoba (AFM).

The November 2002 Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders is an excellent online resource for anyone interested in the latest research on the treatment of dual diagnosis.

Treatment of Drug-Dependent Individuals with Comorbid Mental Disorders (1997) promotes effective treatment by reporting state-of-the-art treatment research on individuals with comorbid mental and addictive disorders and research on HIV-related issues among people with comorbid conditions. NCADI # M172; NTIS # 97-181580, Research Monograph 172.
For additional research on alcohol see the Mental Health & Substance Abuse – Comorbidity/Co-occurring Disorders/Dual Diagnosis section of the Office of Applied Studies website, Substance Abuse and Mental Health Services Administration (SAMHSA).

For more information on addiction research see the Addiction Research section.

Online Resources – Schizophrenia and Dual Diagnosis

Concurrent Disorders and Schizophrenia: A National Awareness Strategy(December 2006) summarizes the various initiatives underway across the country that are improving the lives of those with concurrent disorders. Schizophrenia Society of Canada.

Back to Top

Online Resources – Screening and Dual Diagnosis

Screening is the process of determining whether you may require professional help for a particular problem.

"Do I have a drug problem?" (*) is an online test you can take to determine if you have a problem with drugs.

If you are looking for more addiction tests for you or a significant other, see the Addiction Test section. If you are a clinician see the Screening and Assessment section.

(*) Source: Join Together, a project of Boston University School of Public Health

Online Resources – Trauma and Dual Diagnosis

David Baldwin’s Trauma Information Pages is an award-winning site on the topic of trauma.

Descriptions of Therapy Modalities and Philosophies (August 2007) is a comprehensive list of treatment modalities for trauma including general models, short-term trauma models, integrated models for trauma and substance abuse, and integrated models for trauma and mental health disorders. New York City Alliance Against Sexual Assault.

The PTSD Information Center contains in-depth information on PTSD and traumatic stress for a general audience.

Implementing Seeking Safety therapy for PTSD and substance abuse: Clinical Guidelines (2002) describes Seeking Safety as a present-focused, coping skill  approach to integrated treatment for PTSD and substance abuse. Lisa M. Najavits, Behavioral Health Recovery Management.

Sexual Abuse and Addiction is an online research bibliography. Rutgers University Center of Alcohol Studies

Back to Top

Online Resources – Treatment and Dual Diagnosis

Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse  (1996) Treatment Improvement Protocol (TIP) 9,   Richard Ries, Substance Abuse and Mental Health Services Administration (SAMHSA).

Clinical Training Guidelines for Co-Occurring Mental Health and Substance Use Disorders(September 2003) are intended for use by trainers, clinical supervisors and program administrators to support the planning and development of training for clinical staff for working with the dually diagnosed. Winnipeg Region Co-Occurring Disorders Initiative

Partnering with Families Affected by Concurrent Disorders: Facilitators’ Guide (2007) is a manual designed for therapists to provide evidence-based services for family members of those affected by dual diagnosis. Centre for Addiction and Mental Health (CAMH). 

A Family Guide to Concurrent Disorders (2007) is the workbook for family members. See “Partnering with Families …” above for the Facilitators’ Manual.

TIP 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders identifies key elements for programming for co-occurring disorders in substance abuse treatment agencies. The elements described have relevance for mental health agencies and other service systems that seek to coordinate mental health and substance abuse services for their clients who need both.

Substance Abuse Treatment for Persons with Co-Occurring Disorders Inservice Training (2007) is an in-service training for clinicians based on Treatment Improvement Protocol (TIP) 42 Substance Abuse Treatment For Persons With Co-Occurring Disorders. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 07-4262.

Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities (1998) addresses problems that may arise when treating people with co-existing addiction and physical, sensory, or cognitive disabilities. Treatment Improvement Protocol (TIP) 29. DHHS Publication 98-3249.

Back to Top

Online Resources – Treatment Directory for Dual Diagnosis

National Program Inventory – Concurrent Mental Health and Substance Use Disorders (2001) is a directory which lists dual diagnosis programs across Canada. Cat. No. H39-599/2001-1E. Health Canada.

For a listing of other treatment programs in Canada that treat dual diagnosis visit our sister website Canadadrugrehab.ca.

Online Resources – Treatment Guidelines for Dual Diagnosis

Co-Occuring Disorders: Integrated Dual Disorders Toolkit (2003) Substance Abuse and Mental Health Services Administration (SAMHSA) and Robert Wood Johnson Foundation.

Psychopharmacology Practice Guidelines for Individuals with Co-occurring Psychiatric and Substance Use Disorders (COD) (January 2005) recognizes that existing psychopharmacology guidelines have failed to integrate treatment for co-existing mental illness and substance disorders. Ken Minkoff, Behavioral Health Recovery Management.

Service Planning Guidelines Co-Occurring Psychiatric and Substance Disorders (April 2001) formulates guidelines for assessment, treatment, and psychopharmacology of individuals with co-occurring disorders based on evidence-based best practices. Ken Minkoff, Behavioral Health Recovery Management.

Treatment of Dually Diagnosed Adolescents: The Individual Therapeutic Alliance within a Day Treatment Model (July 2000) Elizabeth Driscoll Jorgensen, Richard Salwen, National Institute on Drug Abuse (NIDA). NIH Publication 00-4151.

Online Resources – Women and Dual Diagnosis

Mental Health and Addictions in Women (Spring 2006) includes research on both substance and mental health for women. Centres of Excellence for Women’s Health, Research Bulletin, Volume 5, Number 1 (*).
For more information on women see the women section of Special Populations.

Back to Top

III. VIDEO RESOURCES FOR DUAL DIAGNOSIS (CO-OCCURRING DISORDERS)

Video Resources – Education Videos

Dual Diagnosis: An Integrated Model for Treatment Kenneth Minkoff, MD. Mental Illness Education Project Videos
Dual Diagnosis: An Integrated Model for Treatment PDF This is a PDF that is useful for the video. Kenneth Minkoff, MD. Mental Illness Education
Project Videos
Toll-free: (800)343-5540

Promise of Recovery Gerald T. Rogers Productions.
Toll-free: (800)227-9100

Double Trouble Gerald T. Rogers Productions.
Toll-free: (800)227-9100

Dual Diagnosis (1994) NIDA, Rockville, MD.

Understanding Depression and Addiction (1994) Dennis Daley, Hazelden Publishing

Understanding Major Anxiety Disorders and Addiction (2003) Dennis Daley, Hazelden Publishing

Understanding Personality Problems and Addiction (1995) Dennis Daley, Hazelden Publishing

Understanding Posttraumatic Stress Disorder and Addiction (1994) Dennis Daley, Hazelden Publishing

Understanding Bipolar Disorder and Addiction (Dual Diagnosis Series) (1995) Dennis Daley, Hazelden Publishing

Understanding Schizophrenia and Addiction (2003) Dennis Daley, Hazelden Publishing

Out of the Tunnel and Into the Light Video (1992) Hazelden Publishing
Toll-free: (800)328-9000

The Twelve Steps and Dual Disorders Video (1995) Hazelden Publishing
Toll-free: (800)328-9000.

Video Resources – Anxiety

The series is presented by Charles Linden:

What Are Anxiety Attacks?
What Are Panic Attacks?
 
Anxiety Testimonials

Anxiety/Panic Attacks (February 2007) Matt Montgomery
Recovered from Anxiety and Panic Attacks (February 2007) Mark LaBella

Video Resources – Dual Diagnosis

This series by Dr. David F. O’Connell was taped in Janauary, 2004:

Dual Diagnosis – Part 1
Dual Diagnosis – Part 2
Dual Diagnosis – Part 3
Dual Diagnosis – Part 4

Drug Abuse, Mental Illness and Co-Occurring Disorders Video hosted by Mary Elizabeth Larson of Community Anti-Drug Coalitions of America (CADCA).

Back to Top

Recent YouTube Videos

Reviews

My mom and dad came up for the family program and they had a blast. Learned quite a bit. Alcohol runs in the family on my dad’s side so there’s knowledge in the family, but, of course, there was a different outlook provided here. They learned a lot and it was definitely beneficial to them as well as for me.

- Calgary, AB

View All Reviews