PRACTICAL BUSINESS OF TREATMENT .28. A TREATMENT SYSTEM FOR COMBINED PSYCHIATRIC AND ADDICTIVE ILLNESS

Patients with combined general psychiatric and addictive disorders are a major public health problem in the US, and are being increasingly r ecognized as such world-wide. The authors describe a model treatment s ystem for such patients in one municipal hospital in New York. It is c omposed of three complementary units: a locked ward, a halfway house a nd a day program. Treatment is based on a peer leadership approach cou pled with professional treatment, and provides multiple levels of care to address the needs of respective patients. Of 464 admissions evalua ted and treated, most were from disadvantaged minorities, homeless and abusers of cocaine. All were admitted with acute psychiatric or perin atal presentations, and carried Axis I diagnoses in addition to their substance abuse. Clinical experience over 6 years is reviewed, suggest ing the feasibility of reorganizing general hospital psychiatric servi ces to address the needs of the dually diagnosed.