Treatment of dually diagnosed clients

Up to 80% of people with mental and emotional disorders have abused or will abuse street drugs or alcohol at some point in their lives. Similarly, ove r half of people with substance use disorders are also diagnosed with a men tal disorder at some point. In clinical populations and institutional setti ngs, the numbers are far higher. The term dual diagnosis (coexisting mental and substance use disorders) refers to a large and complex group of people . This article addresses general issues regarding the complexities of dual diagnosis-differential diagnosis. the difficulty of achieving abstinence fo r people who perceive significant benefits from drug use, and the problems due to the historical split between the mental health and substance abuse t reatment systems. Harm reduction, an approach to treating drug-using client s that focuses on the damage done by drugs and alcohol without insisting on abstinence from all psychoactive substances, can offer a useful way of con ceptualizing treatment of dual diagnosis. A treatment group specifically de signed for dually diagnosed clients is described. This group, inspired by t he idea that changes in addictive behavior occur in a series of stages and that motivation can be influenced by the quality of the relationship with t he treatment provider, uses a drop-in structure to provide low-threshold ac cess to supportive treatment, to meet clients "where they are".