This comprehensive clinical handbook provides virtually everything needed to plan, deliver, and evaluate effective treatment for persons with substance abuse problems and persistent mental illness. From authors at the forefront of the dual disorders field, the book is grounded in decades of influential research. Presented are clear guidelines for developing integrated treatment programs, performing state-of-the-art assessments, and implementing a wide range of individual, group, and family interventions. Also addressed are residential and other housing services, involuntary interventions, vocational rehabilitation, and psychopharmacology for dual disorders. Throughout, the emphasis is on workable ways to combine psychiatric and substance abuse services into a cohesive, unitary system of care. Designed in a convenient large-size format with lay-flat binding for ease of photocopying, the volume contains all needed assessment forms, treatment planning materials, and client handouts, most with permission to reproduce.

This book is about how to help people with comorbid psychiatric and substance use disorders manage their illnesses, develop and pursue personal goals, and get on with the business of their lives. In short, this book provides guidance for professionals about facilitating the recovery process in persons with dual disorders (or with a dual diagnosis).

Mental health and substance abuse treatment professionals frequently encounter clients with prominent psychiatric symptoms and problems related to their use of alcohol or drugs. For example, a client with a history of schizophrenia is admitted to a psychiatric hospital for the treatment of an acute exacerbation of psychotic symptoms, and a routine urine screen tests positive for the presence of cocaine and marijuana. During subsequent assessment, the client reveals that he uses crack cocaine whenever he can afford it, and smokes marijuana and drinks alcohol when he is coming down from crack or cannot obtain it. This combination of problems is not unusual.

As another example, a client with alcoholism who has had several prior episodes of inpatient detoxification calls her substance abuse counselor in the midst of a relapse, and describes struggling with suicidal thoughts and feelings. After steps have been taken to assure her safety, a closer examination of her mental health indicates that she has been struggling with mood problems for many years, and that her emotions fluctuate from the depths of despair to the elation, overconfidence, and euphoria of mania. Again, both substance abuse problems and mental health symptoms are present in a client seeking treatment for one of the disorders.

Traditionally, the most common approach to treating such clients with dual disorders has been to identify one disorder as “primary” and the other as “secondary,” and to focus attention first on treating the primary disorder. Treatment of the other disorder is only attempted when the primary disorder has been successfully managed. Alternatively, sometimes clients with dual disorders are referred to different clinicians (and different agencies) to be given simultaneous treatment of their substance abuse and mental health problems.

Sadly, these traditional approaches to treating dual disorders have been shown to be ineffective for the care of either psychiatric or substance use disorders. Most often, efforts to treat one disorder without attending to the other have been unsuccessful; invariably, clients relapse in one disorder and then the other. On the rare occasions when clients receive treatment for both disorders in separate systems, differences between mental health and substance abuse treatment philosophies and the lack of coordination between different clinicians have doomed these efforts to failure.