Assessment and classification of patients with psychiatric and substance abuse syndromes

The article reprinted here was first published in the October 1989 issue of Hospital and Community Psychiatry, at a time when large numbers of patient s who would formerly have been institutionalized were living in the communi ty and had much greater access to alcohol and drugs. Clinicians were increa singly encountering the diagnostic and treatment challenges presented by pa tients with mental illness and substance use disorders. In this paper Dr Le hman and his colleagues describe issues that must be addressed in the asses sment of patients who may have a dual diagnosis. In the early phases of tre atment, two major pitfalls exist for the clinician: failure to consider tha t the patient may have dual disorders and presumption of the primacy of eit her the psychiatric or the substance use disorder Decisions about longterm treatment depend on the clinician's hypothesis about why the patient has a dual diagnosis. The authors discuss four hypotheses about how dual disorder s develop. The discussion section raises numerous questions that more than a decade later continue to be addressed by researchers on dual disorders.