This TIP, titled Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug (AOD) Abuse, provides practical information about the treatment of patients with dual disorders, including the treatment of AOD patients with mood and anxiety disorders, personality disorders, and psychotic disorders. This TIP also provides pragmatic information about systems and linkage issues relative to the AOD and mental health treatment systems. There is also a discussion about pharmacologic management of patients with dual disorders.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Chapter 1 --Introduction
  • Overview
  • Contents
• Chapter 2—Dual Disorders: Concepts and Definitions
  • The Relationships Between AOD Use and Psychiatric Symptoms and Disorders
  • The Terminology of Dual Disorders
  • AOD Abuse, Addiction, Dependence, Misuse
• Chapter 3 -- Mental Health And Addiction Treatment Systems: Philosophical and Treatment Approach Issues
  • Introduction
  • Treatment Systems: Mental Health, Addiction, And Medical
  • Treatment Models: Sequential, Parallel, Or Integrated
  • Critical Treatment Issues For Dual Disorders
  • General Assessment Issues
• Chapter 4—Linkages For Mental Health and AOD Treatment
  • Overview
  • Policy and Planning Structures
  • Funding and Reimbursement
  • Data Collection and Needs Assessment
  • Program Development
  • Screening, Assessment, And Referral
  • Case Management
  • Staffing
  • Training and Staffing
  • Linkages With Social Service Systems
  • Linkages With the Health Care System
  • Linkages With the Criminal Justice System
• Chapter 5—Mood Disorders
  • Definitions and Diagnoses
  • Prevalence
  • Differential Diagnosis
  • Stages of Assessment
  • Treatment Strategies, Issues, and Goals
  • Reassessment and Reassessment...
• Chapter 6—Anxiety Disorders
  • Definitions and Diagnoses
  • Prevalence
  • Differential Diagnosis
  • Acute Assessment Issues
  • Subacute Assessment Issues
  • Long-Term Assessment Issues
  • Acute Treatment Strategies
  • Subacute Treatment Strategies
  • Long-Term Treatment Issues
  • Use of 12-Step and Other Self-Help Programs
• Chapter 7—Personality Disorders
  • Overview
  • Key Issues and Concerns
  • Borderline Personality Disorder
  • Antisocial Personality Disorder
  • Narcissistic Personality Disorder
  • Passive-Aggressive Personality Disorder
  • Coordination of Care
• Chapter 8—Psychotic Disorders
  • Dual-Focus Perspective
  • Definitions and Diagnoses
  • Prevalence
  • Case Examples
  • Acute Assessment
  • Comprehensive Assessment
  • Treatment Issues
• Chapter 9—Pharmacologic Management
  • Pharmacologic Risk Factors
  • A Stepwise Treatment Model
  • Specific Medications and Recovery
  • Drug Interaction Cautions
• Appendix A -- Bibliography
• Appendix B—Treatment of Patients With Dual Disorders: Sample Cost Data
• Appendix C—Federal Resource Panel
• Appendix D—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Anna Marsh, PhD, and Sandra Clunies, MS, served as the Government project officers. Elayne Clift, MA, Carolyn Davis, Joni Eisenberg, Mim Landry, and Janice Lynch served as writers.

The opinions expressed herein are those of the consensus panel participants and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.

DHHS Publication No. (SMA) 95-3061. Printed 1994. Reprinted 1995.