The Dually Diagnosed

Treatment of even the accurately dually diagnosed is limited by the specialization of the professionals. Their intellectual biases differ and their therapeutic approaches can be hard to reconcile: Is one disorder secondary to the other? Should the clinician be supportive or confrontational? Should medication be prescribed? Or hospitalization? Or a twelve-step program? As the number of seriously ill substance abusers in outpatient settings multiplies with the ascendance of managed care and its attendant cost restrictions, more and more practitioners of every stripe will encounter the therapeutic dilemmas posed by the dually diagnosed. Dennis Ortman, challenging the conventional wisdom that splits treatment between the psychological and medical arenas in order to address both, argues that clinicians should be prepared to treat the entire patient in one therapeutic space. To that end, he offers principles, strategies, and techniques consistent with the goal of an integrated treatment model. His presentation_based on interviews with therapists experienced with the dually diagnosed, buttressed by his research into the nature of substance abuse, and animated with clinical examples_will support practitioners in both the addiction and mental health fields while also stimulating dialogue among them and contributing to the ongoing debate.