Overview
Dual diagnoses have been neglected for a long time. Dual diagnosis also refers to a co-occurring condition in which a person is simultaneously diagnosed with an Axis I and an Axis II psychiatric disorder. While Axis I conditions are considered more or less amenable to treatments such as individual therapy and psychotropic drugs (e.g., antipsychotic, anxiolytic, and antidepressant medications), Axis II conditions are typically considered more resistant or even refractory to such treatments.
Common Axis I conditions that may be treated though drug therapy, counseling, or a combination of the two include (but are not limited to) major depressive disorder, obsessive-compulsive disorder, generalized anxiety disorder, delusional disorder, and schizophrenia. Axis II conditions are limited to mental retardation and the personality disorders such as borderline personality disorder and antisocial personality disorder.
These conditions were originally separated from the Axis I conditions to highlight their intractability to treatment, although there is some evidence to suggest that personality disorders may be managed through long-term individual therapy. The fact that autistic disorder is coded on Axis I is one of the many criticisms of the DSM-IV-TR (the diagnostic manual for mental disorders published by the American Psychiatric Association), as this falsely implies that austic disorder can be "cured" through popular but fad treatments. Emerging literature has proved that dual diagnosis has become a contemporary issue that require a multidimensional service delivery system in order to meet the needs of people with comorbidity conditions.(Regier,1990 and Hall,1996) agrees that " It is a well-known, but poorly addressed fact that drug and alcohol problems often co-exist with mental disorders."
The first treatment interventions and integrated treatment approach for people who had dual diagnosis began in 1984 in the New York State Office of Mental Health system (Sciacca, 1987, 1991, 1996). This began in an outpatient mental health clinic and expanded to a New York State-wide initiative. The MICAA training site for program and staff development New York State-wide was created specifically for workforce development and program implementation across NY State. This initiative crossed systems to include substance abuse programs, homeless services, criminal justice services and more. It included inpatient, outpatient and residential treatment. This initiative included clinical materials including screening, assessment, outcome measures and treatment materials; curriculum and training materials; program development and implementation materials (Sciacca, 1990). This treatment approach, training curriculum and program implementation model was also adapted across systems in various states including Michigan (Sciacca, 1995 and Sciacca & Thompson, 1996). It included programs for the families of the dually diagnosed (Sciacca & Hatfield, 1995) and consumer led self-help programs (Sciacca, 1997). A specific curriculum served as an addendum to the SAMHSA-CMHS Managed Care Initiative Co-Occurring disorder report (Sciacca, 1998). Other states and cities who initiated this model include Tennessee, Alaska, Georgia, Kentucky, Washington DC, Dallas, Texas, among numerous others (Sciacca, 1995, 1997, 1998, 1999, 2001, 2003). In 1993 evidence based models including motivational interviewing, the stages of change and cognitive behavioral therapy correlates were integrated into the dual diagnosis treatment model and comprise the treatment approach and integrated care model that exists today (Sciacca, 1997, 2007, 2008, 2009, 2011).
However, research has shown that there are only a few if any institutions that are geared to address the complex needs of people with dual diagnosis (Crawford, 2001). This brings the fact in agreement to Reiss' discovery that despite the increase of dual diagnosis both in Australia and across the world; service distribution systems requires to be improved meet the needs of this group (Reiss, 1992). With this in mind one would agree that this issue has been historically neglected and there has been limited attention which has indirectly contributed to poor services to people with dual diagnosis (Allsop, 2008).
Read more about this topic: Dual Diagnosis