By Alan Ickowitz, Psy.D.

At one time or another during the course of a person’s life, an individual may struggle with a psychological or mental health issue that will lead him or her to seek treatment through counseling or psychotherapy.  Depression, anxiety, post-traumatic stress, issues of adjustment to major life changes, and sexual disorders are some of these conditions.  Similarly, there are those individuals who may seek out help because their use of alcohol or other drugs has become problematic and has led to much pain and suffering.  But what if a person was attempting to overcome both alcohol/drug addiction and another mental health problem at the same time? What if that person had been trying to cope with episodes of depression and he/she also developed a dependency on pain medications or cocaine? In this type of a situation, the term dual diagnosis would be said to apply because that person would have two co-occurring disorders and consequently two diagnoses.

The best available data on the prevalence of dual diagnosis comes from the National Institute of Mental Health Epidemiological Catchment Area Study (Reiger, et al. 1990).  This survey looked at over 20,000 people in 5 cities and found that as many as 1 out of every 2 -3 people who comes to either a mental health or substance abuse professional seeking assistance to manage one condition, will also have a second co-occurring disorder requiring evaluation and treatment.  Historically, that treatment occurred in either a “parallel” or “sequential” form.  In a parallel approach, the client received mental health services from one clinician or facility to deal with his mental disorder and also maintained a second relationship with a person or facility able to provide substance abuse treatment.  The client (or the insurance company) paid two providers and her treatment was separated into two distinct and separate interventions.  Alternatively, a client was often treated sequentially, that is, she would be expected to seek and receive treatment for one problem before the other could be addressed.

More recently, however, the National Advisory Council for Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services (Rockville, MD 1999) recommended that “the delivery of mental health and substance-related treatment and rehabilitation should be reorganized to provide integrated services that are responsive to the unique, complex interactivity of co-occurring disorders” (p.23).  This “integrated” model recommends that a single professional or facility trained in both mental health and substance abuse provide comprehensive treatment to addresses both disorders simultaneously.

Some of the advantages of this integrated treatment approach would include clients being less likely to receive contradictory or conflicting treatment strategies; they would not be burdened by having to travel to two settings and to keep two sets of appointments; they would be less financially burdened; they could expect greater continuity of care over time and expect treatment interventions to be specifically tailored for them based on where they might be in the recovery process.

As a clinical psychologist specializing in integrated treatment for the dually diagnosed, I attempt to provide my clients with the opportunity to develop a trusting, therapeutic relationship with a single individual who can assist them in learning how to effectively deal with their multiple conditions and the often-complex interaction these conditions have with each other.