Dual diagnosis: 15 years of progress

In the following commentary on the article by Dr. Lehman and others on dual diagnosis, reprinted on page 1119 from the October 1989 issue of Hospital and Community Psychiatry, Drs, Drake and Wallach discuss the development of clinical understanding of dual diagnosis since the 1980s, Research has shown that among persons with serious mental illness, substance abuse is an underlying factor in violence, incarceration, treatment noncompliance, and HIV risk. Findings support the development of integrated treatment programs that address both types of disorder. Drs, Drake and Wallach describe four perspectives on dual diagnosis-medical, moralistic, psychosocial risk, and phenomenological, They argue that the emphasis on diagnosis and illness may have delayed the development of public policies and programs to address risks for substance abuse inhering in social and environmental settings, such as housing shortages and lack of employment opportunities.