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Volume 10
Issue 1
Online publication date 2014-01-17
Title Evaluation of the qualitative and quantitative characteristics of dual diagnosis (Pilot Study)
Author Maria Prodromou, Savoula Ghobrial, Koukia Eumorfia
Objective: Dual diagnosis is a special case of psychiatric co morbidity in which the drug dependent patient qualifies for other than dependence co-occurring mental health disorder. This old term is still maintained in bibliography in order to underline the difficulties in treating these patients. This pilot study was conducted using a naturalistic approach to study for eighteen months. Clients were admitted as inpatients is Residential Therapeutic Rehabilitation Program offered by the Mental Health Services in Cyprus. 
 Methods: Forty-five consecutive patients admitted to the Residential Therapeutic Rehabilitation Program (RTRP) under the Mental Health Services in Cyprus during the period of January 2009 to June 2010. Primary outcomes were the coexistence of psychiatric disorder and substance use disorder, the client profile with dual diagnosis and treatment retention. The EuropASI questionnaire and examination of personal records were used, which included the psychiatric diagnosis of the patients according to the DSM-IV Results: A total of forty five patients were used, 30 were males (80%) with mean age 27.5 ± 6.7, and 15 were females, (20%) with mean age 26.4 ± 4.1. The study revealed that 33.3% of patients suffered with psychiatric disorder with coexistence of drug dependency, thus, showing that only a minority of patients admitted to the (RTRP) in Mental Health Services have double diagnosis. Additionally the most commonly appeared psychiatric disorder is mood disorder. The psychiatric disorder is often associated with the main drug use (heroin, cocaine, THC e.t.c), further more patients diagnosed with double diagnosis often abandoned the Residential Rehabilitation Program early. Results support that the group of dually diagnosed and the group with drug-dependence are showing differences in relation to their treatment retention (Log Rank Mantel-Cox test shown Chi-Square: 4.52, df=1, p< .05). In conclusion, the results have shown the individual characteristics of the clients with dual diagnosis in comparison with clients with substance use disorder. The characteristics included e.g. the educational background, their occupation, their police record, their family and interpersonal relationships.
Conclusion: Despite the fact that the minority of the patients admitted in (RTRP) have double diagnosis, this study adds to the evidence that drug dependent patients with a co morbid mental health disorder show worse prognosis. Dual diagnosis was found to negatively affect prognosis in patients with drug dependence. Concluding this pilot study is supporting those clients that are diagnosed with co morbid disorder should be assessed and evaluated at the beginning of their treatment in order to offer them care that is meeting their needs and encourage them to adhere with their treatment.

Allebeck P, Adamsson C, Engström A.(1993), Cannabis and schizophrenia: a longitudinal study of cases treated in Stockholm County. Acta Psychiatrica Scandinavica, 88(1):21-4,
Andréasson S, Allebeck P, Rydberg U. (1989) Schizophrenia in users and nonusers of cannabis. Acta Psychiatrica Scandinavica, 79(5):505-10,
Baker A, Lewin T, Reichler H, Clancy R, Carr V, Garrett R, et al.(2002), Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction, 97(10):1329-37. Epub 2002/10/03
Baigent M, (2012),Managing patients with dual diagnosis in psychiatric practice. Current Opinion in Psychiatry, 25(3):201,
Barrowclough C, Haddock G, Beardmore R, Conrod P, Craig T, Davies L, et al. (2009) Evaluating integrated MI and CBT for people with psychosis and substance misuse: recruitment, retention and sample characteristics of the MIDAS trial. Addictive behaviors, 34(10):859-66,
Bibb JL, Chambless DL, (1986) Alcohol use and abuse among diagnosed agoraphobics. Behav Res Ther. 24(1):49-58. Epub 1986/01/01
Brewer DD, Catalano RF, Haggerty K, Gainey RR, Fleming(1998), CB. RESEARCH REPORT A meta‐analysis of predictors of continued drug use during and after treatment for opiate addiction. Addiction. 93(1):73-92,
Bunt GC, Muehlbach B, Moed CO(2008), The Therapeutic Community: an international perspective. Subst Abuse, 29(3):81-7. Epub 2008/12/02
Cacciola, J.S.,Alterman, A.I.,McLellan, A.T.,Lin, Y.T., & Lynch, K.G (2007). Initial evidence for the reliability and validity of a lite version of the addiction severity index. Drug and Alcohol Dependence, 87(2-3), 297-302,
Carey KB, Purnine DM, Maisto SA, Carey MP, (2001) Enhancing readiness-to-change substance abuse in persons with schizophrenia. A four-session motivation-based intervention. Behav Modif, 25(3):331-84. Epub 2001/06/29
Chambers RA, Sentir AM, Conroy SK, Truitt WA, Shekhar A, (2010) Cortical-striatal integration of cocaine history and prefrontal dysfunction in animal modeling of dual diagnosis. Biol Psychiatry, 67(8):788-92. Epub 2009/11/03
Chan Y. Biostatistics 203 (2004), Survival analysis. Singapore medical journal. 45:249-56
Cheryl D. Swofford, John W.Kasckow, Geri Scheller- Gilkey,Lawrence B. Inderbitzin (1995).Substance use: a powerful predictor of relapse in schizophrenia. Schizophrenia Research 20(1996),145-151,
Chouljian TL, Shumway M, Balancio E, Dwyer EV, Surber R, Jacobs M.(1995), Substance use among schizophrenic outpatients: prevalence, course, and relation to functional status. Ann Clin Psychiatry, 7(1):19-24. Epub 1995/03/01
Christie KA, Burke JD, Jr., Regier DA, Rae DS, Boyd JH, Locke BZ.(1988) Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. Am J Psychiatry. 145(8):971-5. Epub 1988/08/01
Cleary M, Hunt G, Matheson S, Siegfried N, Walter G.(2008), Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev.1
Coombes L, Wratten A.(2007),The lived experience of community mental health nurses working with people who have dual diagnosis: a phenomenological study. J Psychiatr Ment Health Nurs. 14(4):382-92. Epub 2007/05/23
Conway KP, Kane RJ, Ball SA, Poling JC, Rounsaville BJ.(2003), Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug Alcohol Depend. 71(1):65-75. Epub 2003/06/25
Conway KP, Swendsen JD, Rounsaville BJ, Merikangas KR.(2002) Personality, drug of choice, and comorbid psychopathology among substance abusers. Drug Alcohol Depend. 65(3):225-34. Epub 2002/02/14
Cosci F, Fava G.(2011), New clinical strategies of assessment of comorbidity associated with substance use disorders. Clinical Psychology Review. 31(3):418-27,
Comtois KA, Tisdall WA, Holdcraft LC, Simpson T.(2005), Dual diagnosis: impact of family history. Am J Addict. 14(3):291-9. Epub 2005/07/16
Dolan SL, Bechara A, Nathan PE.(2008),Executive dysfunction as a risk marker for substance abuse: the role of impulsive personality traits. Behav Sci Law. 26(6):799-822. Epub 2008/11/29
Drake RE, Mueser KT.(2000), Psychosocial approaches to dual diagnosis. Schizophr Bull. 26(1):105-18. Epub 2001/02/07
Drake RE, Osher FC, Wallach MA.(1989),Alcohol use and abuse in schizophrenia. A prospective community study. J Nerv Ment Dis. 177(7):408-14. Epub 1989/07/01
Drake RE, Morrissey JP, Mueser KT.(2006), The challenge of treating forensic dual diagnosis clients: comment on "integrated treatment for jail recidivists with co-occurring psychiatric and substance use disorders". Community Ment Health J. 42(4):427-32. Epub 2006/08/15
Drake RE, Mercer-McFadden C, Mueser KT, McHugo GJ, Bond GR.(1998), Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull. 24(4):589-608. Epub 1998/12/16.
Emmelkamp PMG, Vedel E.(2006), Evidence-based treatment for alcohol and drug abuse: a practitioner's guide to theory, methods, and practice: Brunner-Routledge
Fussinger C,(2010),[Elements for an history of the therapeutic community in Western psychiatry of the 2nd half of the 20th century]. Gesnerus. 67(2):217-40. Epub 2010/01/01. Elements pour une histoire de la communaute therapeutique dans la psychiatrie occidentale de la seconde moitie du 20e siecle
Havassy B, Allvidrez J, Owen K. (2004),Comparisons of patients with comorbid psychiatric and substance use disorders: Implications for teatment and service delivery. Am J Psychiatry. January 161:139-145
Kessler, R .(2004),The epidemiology of dual diagnosis. Biol Psychiatry 56:730–737,
Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ. (1996),The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry. 66(1):17-31. Epub 1996/01/01
Kotov R, Gamez W, Schmidt F, Watson D. Linking (2010), "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychol Bull. 136(5):768-821. Epub 2010/09/02
Klein DF (1980),Anxiety reconceptualized. Compr Psychiatry. 21(6):411-27. Epub 1980/11/01
Kokkevi A, Stefanis N, Anastasopoulou E, Kostogianni C.(1998), Personality disorders in drug abusers: prevalence and their association with AXIS I disorders as predictors of treatment retention. Addict Behav. 1998;23(6):841-53. Epub 1998/11/05
Lehman AF, Myers CP, Corty E, Thompson JW.(1994),Prevalence and patterns of "dual diagnosis" among psychiatric inpatients. Compr Psychiatry. 35(2):106-12. Epub 1994/03/01
Lim KO, Wozniak JR, Mueller BA, Franc DT, Specker SM, Rodriguez CP, et al.(2008), Brain macrostructural and microstructural abnormalities in cocaine dependence. Drug and alcohol dependence. 92(1-3):164-72,
Maser, JD . & Patterson, T. (2002) Spectrum and nosology: implications for DSM-5 Psychiatric Clinics of North America, December, 25(4) p855-885
McLellan, AT, Cacciola, JS, Alterman, AI, Rikoon, SH & Carise, D. (2006). The Addiction Severity Index at 25: origins, contributions and transitions. American Journal of Addiction. 15 (2) (113-24),
Moline RA.(1977), The therapeutic community and milieu therapy: a review and current assessment. Community Ment Health Rev. 2(5):1, 3-13. Epub 1976/12/13
Mueller A, Claes L, Mitchell JE, Wonderlich SA, Crosby RD, de Zwaan M. (2010),Personality prototypes in individuals with compulsive buying based on the Big Five Model. Behav Res Ther. 48(9):930-5. Epub 2010/06/15
Negrete,J.C.(2003),Clinical aspects of substance abuse in persons with schizophrenia. Can J Psychiatry 48(1):14–21
Nestler, E.J., and Carlezon, W.A. Jr.(2006), The mesolimbic dopamine reward circuit in depression. Biol Psychiatry 59(12):1151–1159,
Osher FC, Drake RE, Noordsy DL, Teague GB, Hurlbut SC, Biesanz JC, et al.(1994),Correlates and outcomes of alcohol use disorder among rural outpatients with schizophrenia. J Clin Psychiatry.55(3):109-13. Epub 1994/03/01
Pedersen K, Waal H, Kringlen E.(2012), Patients with nonaffective psychosis are at increased risk for heroin use disorders. Eur Addict Res. 18(3):124-9. Epub 2012/02/23
Potvin S, Sepehry AA, Stip E.(2006), A meta-analysis of negative symptoms in dual diagnosis schizophrenia. Psychol Med. 36(4):431-40. Epub 2006/03/16
Prendergast M, Podus D, Finney J, Greenwell L, Roll J.(2006), Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 101(11):1546-60. Epub 2006/10/13
Potvin S, Sepehry AA, Stip E.(2007), Meta-analysis of depressive symptoms in dual-diagnosis schizophrenia. Aust N Z J Psychiatry. 41(10):792-9. Epub 2007/09/11
Quello, S.B.; Brady, K.T.; and Sonne, S.C.(2005),Mood disorders and substance abuse disorders: A complex comorbidity. Science & Practice Perspectives 3(1):13–24.
Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al.(1990), Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 264(19):2511-8. Epub 1990/11/21.04/07/10
Robinson JA, Sareen J, Cox BJ, Bolton JM.(2009),Correlates of self-medication for anxiety disorders: results from the National Epidemiolgic Survey on Alcohol and Related Conditions. The Journal of nervous and mental disease, 3(12):873
Sacks S, McKendrick K, Sacks JY, Cleland CM.(2010), Modified therapeutic community for co-occurring disorders: single investigator meta analysis. Subst Abus. 31(3):146-61. Epub 2010/08/06
Sareen J, Chartier M, Kjernisted KD, Stein MB (2001), Comorbidity of phobic disorders with alcoholism in a Canadian community sample. Can J Psychiatry. 46(8):733-40. Epub 2001/11/06
Semple DM, McIntosh AM, Lawrie SM.(2005), Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology. 19(2):187-94,
Shen Y, Wang E, Wang X, Lou M.(2012), Disrupted Integrity of White Matter in Heroin-addicted Subjects at Different Abstinent Time. J Addict Med. Epub 2012/04/27
Specka M, Boning A, Scherbaum N.(2011),[Contingency management in opioid substitution treatment]. Fortschr Neurol Psychiatr. 79(7):395-403. Epub 2010/11/26. Kontingenzmanagement in der Substitutionsbehandlung Opiatabhangiger
Solowij N, Yucel M, Respondek C, Whittle S, Lindsay E, Pantelis C, et al (2011). Cerebellar white-matter changes in cannabis users with and without schizophrenia. Psychol Med. 41(11):2349-59. Epub 2011/04/07,
Sorensen JL, Andrews S, Delucchi KL, Greenberg B, Guydish J, Masson CL, et al.(2009) Methadone patients in the therapeutic community: a test of equivalency. Drug Alcohol Depend. 100(1-2):100-6. Epub 2008/11/18
Stitzer M, Petry N.(2006), Contingency management for treatment of substance abuse. Annu Rev Clin Psychol. 2:411-34. Epub 2007/08/25
Stitzer ML, Vandrey R.(2008),Contingency management: utility in the treatment of drug abuse disorders. Clin Pharmacol Ther. 83(4):644-7. Epub 2008/02/29
Strang J, McCambridge J, Best D, Beswick T, Bearn J, Rees S, et al.(2003), Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. BMJ. 326(7396):959-60. Epub 2003/05/03
Strakowski SM, DelBello MP. (2000), The co-occurrence of bipolar and substance use disorders. Clinical Psychology Review. 20(2):191-206,
Vega WA, Canino G, Cao Z, Alegria M.(2009), Prevalence and correlates of dual diagnoses in US Latinos. Drug and alcohol dependence. 100(1-2):32-8,
Warner TD, Behnke M, Eyler FD, Padgett K, Leonard C, Hou W, et al.(2006), Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children. Pediatrics. 118(5):2014-24. Epub 2006/11/03.
Wise BK, Cuffe SP, Fischer T.(2001),Dual diagnosis and successful participation of adolescents in substance abuse treatment. Journal of Substance Abuse Treatment. 21(3):161-5.
Yucel M, Zalesky A, Takagi MJ, Bora E, Fornito A, Ditchfield M, et al. (2010), White-matter abnormalities in adolescents with long-term inhalant and cannabis use: a diffusion magnetic resonance imaging study. J Psychiatry Neurosci. 35(6):409-12. Epub 2010/08/25.26.
Zuo L, Gelernter J, Kranzler HR, Stein MB, Zhang H, Wei F, et al.(2010), ADH1A variation predisposes to personality traits and substance dependence. Am J Med Genet B Neuropsychiatr Genet. 153B(2):376-86. Epub 2009/06/16.
Keywords Addiction, drug dependence, dual diagnosis, comorbidity, rehabilitation, relapse prevention
Pages 11-19
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