CHARACTERISTICS OF DUAL DIAGNOSIS PATIENTS ADMITTED TO AN URBAN, PUBLIC PSYCHIATRIC-HOSPITAL - AN EXAMINATION OF INDIVIDUAL, SOCIAL, AND COMMUNITY DOMAINS

The study provides descriptive data on a large, diverse sample of dual ly diagnosed patients from an urban psychiatric inpatient setting, uti lizing a comprehensive array of clinical, social and community functio ning measures. The intent is to provide more useful and reliable infor mation, particularly concerning African-Americans with a dual diagnosi s in the public sector. Over a one year period, all persons admitted t o a public psychiatric hospital with a DSM-III-R psychiatric diagnosis and a positive screen for substance abuse problems using clinical and structured measures (n = 486) were interviewed on the Addiction Seven ty Index (ASI) and other measures to assess community and social funct ioning, alcohol and drug use, psychiatric problems, and service histor ies. The majority of participants were found to have serious economic and employment problems, undesirable living arrangements, limited or c onflictive family or social relationships, and some record of arrest. The ASI problem areas most to least in need of treatment were: psychia tric, alcohol and drug abuse, employment, family/social, legal, and me dical. Substances most often currently abused were alcohol, cocaine, a nd cannabis; there was a high rate of polydrug abuse. Participants had experienced a median of 3.0 previous psychiatric hospitalizations, fe wer outpatient substance abuse treatments, and limited community menta l health contact. Some subgroup differences based on gender, age, and race were found which have implications for community treatment planni ng. The study results document the extreme heterogeneity in the dually diagnosed as well as their multiple treatment needs. To better inform treatment planning, future research on dual diagnosis should attempt to establish meaningful subgroups relevant to service needs and should utilize diverse clinical and functioning measures.