Special Considerations for Dually Diagnosed Schizophrenics and Their Families

Abstract

Within a heterogeneous population such as the “dually diagnosed,” overarching general principles are essential guides in clinical practice and training. Without coexisting efforts to characterize the unique features and needs of special populations, however, treatment efforts will ultimately fall short of their objectives. One population warranting such specialized attention are those individuals with schizophrenia and co-occurring substance use problems. The comorbidity of substance abuse and schizophrenia has been targeted as a significant problem (Schneier and Siris,1987; Salloum, Moss, and Daley, 1991), and one that has dramatic implications for the rising percentage of schizophrenics who become homeless (Koegel, Burnham, and Ferry, 1988; Drake, Osher, and Wallach, 1991). Indeed, findings from the Epidemiological Cachement Area (ECA) studies suggest that alcoholics are four times more likely than nonalcoholics to receive an additional diagnosis of schizophrenia (Heizer and Pryzbeck, 1988); conversely, for diagnosed schizophrenics, the prevalence rate for lifetime substance abuse or dependence has been estimated to be as high as 47% (Regier, Farmer, Rae et al., 1990). Yet, as with other subgroups of dually diagnosed psychiatric patients, underrecognition and misdiagnosis of substance use problems prevails, and treatment interventions often do not take into account the multiple problems faced by these patients. Thus, the first half of this chapter will take as its focus the dually diagnosed schizophrenic and the unique diagnostic and treatment dilemmas that arise when working with this special population. The second half will largely be devoted to presenting an integrated psychoeducational/addictions approach for working with the families of these individuals In this special population, the family plays a crucial role in supporting the identified patient’s (IP) recovery or alternately, in exacerbating the level of stress and vulnerability to relapse. Dually diagnosed schizophrenics are one of the more difficult patient populations to work and live with, particularly due to the feelings of despair, frustration, and hopelessness that can be engendered in clinicians and family members alike. Consequently, one primary aim of this chapter will be to provide the clinician with a framework for conceptualizing manageable and realistic treatment strategies with schizophrenic substance users and their families.