Prevalence
Many clients who report to drugs and alcohol services have some kind of mental health issue. -
Some 74.5% of users of drug services and 85.5% of users of alcohol services experienced mental health problems.
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Most had affective disorders (depression) and anxiety disorders. A relatively high rate of psychosis was also observed.
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Almost 30% of the drug treatment population and over 50% of those in treatment for alcohol problems experienced ‘multiple’ morbidity (co-occurrence of a number of psychiatric disorders or substance misuse problems).
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Some 38.5% of drug users with a psychiatric disorder were receiving no treatment for their mental health problem. Some 44% of mental health service users reported drug use and/or were assessed to have used alcohol at hazardous or harmful levels in the past year.
Source: Co-morbidity of substance misuse and mental illness collaborative study. (COSMIC)
Mind the Gaps the Scottish Executive’s Practice Guidance states that -
up to 3 in 4 drug using clients have been reported as having mental health problems;
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up to 1 in 2 patients with alcohol problems may also have a mental health problem;
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up to 2 in 5 people with mental health problems may have a drug and/or alcohol problems; and
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co-morbidity in general practice in England has risen by 62% between 1993 and 1998.
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Dual diagnosis or complex needs
Dual Diagnosis is a wide term and there is no particular agreement about what it means. Alcohol Concern in its Fact Sheet on Alcohol and Mental Health discusses two basic definitions. -
The co-existence of an alcohol and/or drug misuse or dependence problem and a range of mental health problems or behavioural disorders (a broad unrestricted definition) or
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The co-existence of an alcohol and/ or drug misuse or dependence problem and a ’severe and enduring mental illness’ (a restricted definition)
A severe and enduing mental health problem refers to the kind of symptoms described in DSM IV (Diagnostic and Statistical Manual fourth edition). This is the American Psychiatric Association set of diagnostic criteria for mental health problems. It is hugely influential in the notoriously difficult and inaccurate business of diagnosis. The breadth of the definition matters - a narrow definition restricts the ability of clients to get services.
Rather than dual diagnosis two terms used often are;
co-morbidity and
complex need.
 These both reflect the truth that almost anyone who has worked which everyone has worked with clients will know; that very few people who come in contact with services have only one need. For most people many things are going on - physical and mental health, housing, legal and financial things will be going on as well.
Models of Care,
quotes Krausz (1996) who suggests that there are four categories of ‘dual diagnosis’: -
a primary diagnosis of a major mental illness with a subsequent (secondary diagnosis) of substance misuse which adversely affects mental health
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a primary diagnosis of drug dependence with psychiatric complications leading to mental illness
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a concurrent substance misuse and psychiatric disorder
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an underlying traumatic experience resulting in both substance misuse and mood disorders e.g. post-traumatic stress disorder.
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