Dual diagnosis: management within a psychosocial context

Mohammed T. Abou-Saleh is a reader and honorary consultant in addiction psychiatry in the Department of Mental Health, St George’s Hospital Medical School, University of London, and Clinical Director of Addiction Services and Director of Research and Development in South West London and St George’s Mental Health Trust (Cranmer Terrace, London SW17 0RE, UK. Tel: 020 8725 0368; fax: 020 8725 2914; e-mail: mabousal{at}sghms.ac.uk). He was previously Professor and Chairman of the Department of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health Sciences, United Arab Emirates University and a reader in psychiatry at the University of Liverpool. His research interests include biological psychiatry, dual diagnosis, addiction prevention and psychopharmacology.

Recent developments in UK government policy have highlighted the unmet needs of people with dual diagnosis (comorbidity of substance misuse and psychiatric disorder, particularly severe mental illness). Advances in assessment techniques and diagnostic practice have informed the treatment of comorbidity and improved its outcome. There is growing evidence for the effectiveness of psychosocial interventions such as motivational interviewing and cognitive–behavioural therapy, mostly from US studies. However, within the secondary care provided by addiction and general psychiatric services there are serious implementation barriers related to service organisation, staffing levels, training and – most importantly – the difficulties of engaging people with severe mental illness and comorbid substance misuse in treatment. The evidence for the effectiveness of psychosocial treatments and models of service is reviewed and challenges for optimal practice in the UK are highlighted.

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