Behavioral interventions for dual-diagnosis patients

The co-occurrence of psychiatric disorders and substance use disorders is commonplace. The Epidemiologic Catchment Area Study (ECA) reported that the occurrence of substance abuse or dependence was 16.7% for the general population, 47% for people with schizophrenia, 56% for bipolar patients, 27% for patients with major depression, 32.8% for those with obsessive compulsive disorder, and 35.8% for panic disordered patients. The National Comorbidity Survey in the US and the National Survey of Mental Health and Wellbeing in Australia yielded similar results [1]. Because of the interactions between substance use and psychiatric illness, dual-diagnosis patients commonly show poorer outcomes on many performance measures after treatment. There is more rehospitalization, alcohol and drug use, and co-occurring problems. There is less engagement and follow-through than in single-diagnosis patients, with fewer personal resources to bring to therapy. Intense psychiatric states are common triggers of relapse to substance use, and the term self medication is used commonly to describe the interaction of psychiatric disorders and substance use. Behavioral interventions always have been essential to treatment, but the sequencing and packaging of them have been challenging to health care providers. There are several behavioral therapies-individual, family, and group-that are combined with pharmacotherapies to treat dual-diagnosis patients.