Dual-Diagnosis Management: A Comprehensive Study in the Community Mental Health Center

Dual diagnosis is a relatively new concept which in recent years has changed the methods used in the evaluation and treatment of the mentally ill who are also chemically dependent. This paper examines current practice in this area in the setting of the community mental health center and suggests some alternatives in the treatment of this subset of patients. Information was obtained from the annual reports of two community mental health centers in Nashville. Personnel from these centers were also interviewed. A literature search as well as a telephone survey also provided some of the data. Up to 40 percent of people in the community who have a substance-abuse problem also have a diagnosable mental illness. About 37 percent of alcohol abusers have at least one coexisting mental disorder. In substance abuse treatment centers, the rate of overlapping disorders is about 50 percent to 65 percent. Only 35 percent of mental health centers contacted in a nationwide telephone survey have a dual diagnosis program in place. In mental health centers, the rate of concurrent substance abuse is about 30 percent. Dual-diagnosis day treatment programs are successful in reducing hospitalization rates in these patients. Relatively little has been done to develop community-based treatment facilities for dual-diagnosis patients. Specialized treatment facilities have been demonstrated to be highly effective in the treatment of these individuals. The mental health community needs to move quickly toward the establishment of programs which address both components of the illness of these difficult patients.