A Twist on Dual Diagnosis

By London, Robert T. | Clinical Psychiatry News, January 2005 | Go to article overview

A Twist on Dual Diagnosis


London, Robert T., Clinical Psychiatry News


Now that we are solidly in the 21st century and know the real health effects of cigarette smoking, we psychiatrists should be actively participating in smoking prevention and smoking-cessation treatments.

As medical doctors, we need to change the way we define dual-diagnosis illnesses. Why not consider the dual diagnosis of cigarette smoking and pulmonary disease--or cigarette smoking and cardiac illness--as examples of such illnesses?

The one good thing about smoking is that it is an entirely preventable cause of death, according to Elizabeth M. Whelan. Sc.D., founder and president of the American Council on Science and Health in New York, and a public health expert on cigarette smoking and disease. In her submission on cigarettes as the major preventable cause of premature death in the case of Anderson v. American Tobacco Co. et. al., Dr. Whelan pointed out that as far back as 1984, the American Thoracic Society made smoking the major preventable cause of death and disability in the developed world. Today, of the 2 million total deaths in the United States each year, 450,000 deaths--a full 25%--are directly related to smoking, according to Dr. Whelan. Tobacco use is such a severe public health problem that more than 1 billion people eventually will be killed worldwide by the effects of smoking. This is about one-fifth of all people now living in developed countries, Dr. Whelan wrote.

In my first few years at New York University/Bellevue Hospital Center, I developed one of the earliest smoking-cessation programs in a county hospital. Although it later evolved into the short-term psychotherapy program, smoking cessation was always a major part of its didactic and clinical mission. To help patients quit smoking, I developed my learning, philosophizing, and action (LPA) technique. This cognitive-dialectical approach works not only for short-term psychotherapy but also for habit control. This is how the technique worked with smokers:

* Learning Phase. In this phase, the patient and I discussed the statistics of smoking-related illnesses, such as cancer, heart disease, and pulmonary illnesses. Using the best available knowledge, I helped the patient understand the extent to which smoking was causing severe physiologic damage. I also used this phase to answer any questions the patient had. We explored the positive effects that smoking cessation would yield. As is the case today, the most dramatic results were usually obtained in the area of cardiac health.

* Philosophy Phase. We discussed how the smoking habit had become an addiction and had essentially taken on a life of its own. Whether the habit originated because of peer pressure, as a result of learned behaviors within the family, or through the powerful world of advertising, it had become solidified within the patient's life.

The concepts of addiction and habituation also were explored in this phase. I pointed out that the physical addiction to nicotine is finite in terms of the physical cravings that occur when the patient gives up smoking, and that these cravings disappear in a relatively short time. I also explained that habituation is more psychological than physical, and is linked to behavioral patterns that center around the lighting and smoking of a cigarette, such as always lighting up when talking on the telephone.

The behavioral aspects of cigarette smoking can become so integrated into a patient's lifestyle that they appear to endure longer than the chemical/physiologic addiction to nicotine. These philosophical discussions were critical, because they provided a real--and, from my point of view, desirable--psychological/psychiatric touch to the entire approach. In other words, as the patient learned maladaptive behaviors or lifestyles, he or she also developed habituations that, in the case of smoking, led to addiction. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

A Twist on Dual Diagnosis
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.