Dual-Diagnosis Empirical and Developmental-Humanistic Approaches

  • Alina M. McKenna
  • Alfonso Paredes
Part of the Recent Developments in Alcoholism book series (RDIA, volume 10)


The association between alcohol and/or drug dependence and major psychiatric conditions such as schizophrenia has received increased attention from the professional community. Terms such as “dual diagnosis” used to designate these clinical occurrences have become common, reflecting the interest mentioned. This chapter reviews the prevalence of the association between substance abuse and psychiatric disorder, the nature of the interactions observed, and some of the implications for patient care and health policy. Following this empirical perspective, we present a developmental-humanistic approach that has been used in the psychotherapeutic management of these problems. Our review of information on dual diagnosis suggests that the association between the two processes—substance abuse and psychiatric disorder—is not fortuitous or just the result of environmental conditions. There are complex physiopathological links at the neurobiological level that deserve research attention.


Substance Abuse Negative Symptom Schizophrenic Patient Psychiatric Patient Dual Diagnosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pokorny AD: The multiple readmission psychiatric patient. Psychiatr Q 39:70–78, 1965.PubMedCrossRefGoogle Scholar
  2. 2.
    Gottheil E, McLellan AT, Druly RA: Substance Abuse and Psychiatric Illness. New York, Pergamon Press, 1980.Google Scholar
  3. 3.
    McLellan AT, MacGahan JA, Druley KA: Psychopathology and substance abuse, in Gottheil E, McLellan AT, Druly RA (eds): Substance Abuse and Psychiatric Illness. New York, Pergamon Press, 1980.Google Scholar
  4. 4.
    Ross H, Glaser T, Germanson T: The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry 45:1023–1031, 1988.PubMedCrossRefGoogle Scholar
  5. 5.
    Kiesler C, Simpkins C, Morton T: Prevalence of dual diagnoses of mental and substance abuse disorders in general hospitals. J Hosp Community Psychiatry 42:400–403, 1991.Google Scholar
  6. 6.
    Rice DP, Kelman S: Measuring comorbidity and overlap in the hospital cost for alcohol, drug abuse and mental illness. Inquiry 26:249–260, 1989.PubMedGoogle Scholar
  7. 7.
    Crowe DB, Rosse RB, et al.: Substance use diagnoses and discharge patterns among psychiatric patients. J Hosp Community Psychiatry 42:403–405, 1991.Google Scholar
  8. 8.
    Caton CL, Gralnick A, et al.: Young chronic schizophrenics and substance abuse. J Hosp Community Psychiatry 40:1037–1040, 1989.Google Scholar
  9. 9.
    Negrete GC, Knapp P, et al.: Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychol Med 16:515–520, 1986.PubMedCrossRefGoogle Scholar
  10. 10.
    Richard ML, Liskow BI, et al.: Recent psychostimulant use in hospitalized schizophrenics. J Clin Psychiatry 46:79–83, 1985.PubMedGoogle Scholar
  11. 11.
    Alterman AI: Substance abuse in psychiatric patients, in Alterman AI (ed): Substance Abuse and Psychopathology. New York, Plenum Press, 1985.Google Scholar
  12. 12.
    Muesser KT, Yarnold PR, Levinson DF, et al.: Prevalence of substance abuse in schizophrenia, demographic and clinical correlates. Schizophrenia Bull 16:31–56, 1990.CrossRefGoogle Scholar
  13. 13.
    Lehman AF, Myers CP, et al.: Assessment and classification of patients with psychiatric and substance abuse syndromes. J Hosp Community Psychiatry 40:1019–1025, 1989.Google Scholar
  14. 14.
    Andreasson S, Engstorm A, et al.: Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet 2:1483–1486, 1987.PubMedCrossRefGoogle Scholar
  15. 15.
    Drake RE, Osher FC, et al.: Diagnoses of alcohol use disorder in schizophrenia. Schizophrenia Bull 16:56–67, 1990.CrossRefGoogle Scholar
  16. 16.
    Rounsaville BJ, Anton SF, Carroll K, et al.: Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry 48:43–51, 1991.PubMedCrossRefGoogle Scholar
  17. 17.
    Brady K, Anton R, Ballenger TC, et al.: Cocaine abuse among schizophrenic patients. Am J Psychiatry 147:1164–1167, 1990.PubMedGoogle Scholar
  18. 18.
    Comfort A: Morphine as an antipsychotic. Clin Toxicol 11:383–386, 1977.PubMedCrossRefGoogle Scholar
  19. 19.
    McKenna GC, Fish A, Levine ME, et al.: The use of methadone as a psychotropic agent, in Dupont KD (ed): The First National Conference on Methadone Treatment Proceedings, Vol 2, New York, New York Academy of Sciences, 1973, pp 1317-1324.Google Scholar
  20. 20.
    Dixon L, Haas G, Weiden P, et al.: Acute effects of drug abuse in schizophrenic patients: clinical observations and patients’ self-reports. Schizophrenia Bull 16:69–79, 1990.CrossRefGoogle Scholar
  21. 21.
    Dixon L, Haas G, Weiden P, et al.: Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am J Psychiatry 148:224–230, 1991.PubMedGoogle Scholar
  22. 22.
    Crow TJ: Molecular pathology of schizophrenia more than one disease process? Br Med J 280:66–68, 1980.PubMedCrossRefGoogle Scholar
  23. 23.
    Andreasen NC: Negative versus positive schizophrenia: definition and validation. Arch Gen Psychiatry 39:789–784, 1982.PubMedCrossRefGoogle Scholar
  24. 24.
    Andreasen NC: Negative symptoms in schizophrenia definition and reliability. Arch Gen Psychiatry 39:738–788, 1982.Google Scholar
  25. 25.
    Andreasen NC, Flawn M, et al.: Positive and negative symptoms of schizophrenia: a critical reappraisal. Arch Gen Psychiatry 47:615–622, 1990.PubMedCrossRefGoogle Scholar
  26. 26.
    Stoffelmayer BE, Benijhek LA, et al.: Substance abuse prognosis with an additional psychiatric diagnosis: understanding of the relationship. J Psychoactive Drugs 21:145–152, 1989.CrossRefGoogle Scholar
  27. 27.
    Bowers MB, Mazure MB, et al.: Psychotogenic drug use and neuroleptic response. Schizophrenia Bull 16:81–85, 1990.CrossRefGoogle Scholar
  28. 28.
    Irwin M, Caldwell C, et al.: Major depressive disorder, alcoholism and reduced natural killer cell cytotoxicity: role of severity of depressive symptoms and alcohol consumption. Arch Gen Psychiatry 47:713–719, 1990.PubMedCrossRefGoogle Scholar
  29. 29.
    Seiden LS, Ricarte GE: Neurotoxicity of amphetamine and related drugs, in Meltzer HY (ed): Psychopharmacology. New York, Raven Press, 1987.Google Scholar
  30. 30.
    Losonczy MF, Davidson M, Davis KL: The dopamine hypothesis in schizophrenia, in Meltzer HY (ed): Psychopharmacology. New York, Raven Press, 1987.Google Scholar
  31. 31.
    Peris J, Zahaniser NR: Persistent augmented dopamine release after acute cocaine requires dopamine receptor activation. Pharmacol Biochem Behav 32:71–76, 1989.PubMedCrossRefGoogle Scholar
  32. 32.
    Peris J, Boyson SJ, Cass WA, Curella P, Dwoskin LP, Larson G, Lin LH, Yasuda RP, Zahniser NR: Persistence of neurochemical changes to dopamine systems after repeated cocaine administration. J Pharmacol Exp Ther 253:38–44, 1990.PubMedGoogle Scholar
  33. 33.
    Gawin F: Cocaine addiction: psychology and neurophysiology. Science 251:1558–1586, 1991.CrossRefGoogle Scholar
  34. 34.
    Losonczy MF, Davidson M, Davis KL: The dopamine hypothesis in schizophrenia, in Meltzer HY (ed): Psychopharmacology. New York, Raven Press, 1987.Google Scholar
  35. 35.
    Goldberg TE, Bigelow LB, Weinberger FR, et al.: Cognitive and behavioral effects of the coadministration of deytroamphetamine and haloperidol in schizophrenia. Am J Psychiatry 148:78–84, 1991.PubMedGoogle Scholar
  36. 36.
    Salzman C: The APA Task Force Report on Benzodiazepine Dependence, toxicity and abuse. Am J Psychiatry 148:151–152,1991 (editorial).PubMedGoogle Scholar
  37. 37.
    Smith D, Landry M: Benzodiazepine dependence discontinuation: focus on the chemical dependence detoxification setting and benzodiazepine-polydrug abuse. J Psychiatr Res 24(Suppl): 145–156, 1990.PubMedCrossRefGoogle Scholar
  38. 38.
    Linnoila M: Benzodiazepines and alcohol. J Psychiatr Res 24:121–127, 1990.PubMedCrossRefGoogle Scholar
  39. 39.
    Wolfe HL, Sorensen JL: Dual diagnosis patients in the urban psychiatric emergency room. J Psychoactive Drugs 21:169–175, 1989.PubMedCrossRefGoogle Scholar
  40. 40.
    Frances RJ: Update on alcohol and drug disorder treatment. J Clin Psychiatry 49(Suppl):13–17, 1986.Google Scholar
  41. 41.
    Clark HW, Zweben JE: Legal vulnerabilities in the treatment of chemically dependent dual diagnosis patients. J Psychoactive Drugs 21:251–257, 1989.PubMedCrossRefGoogle Scholar
  42. 42.
    Zweben JE, Smith DE: Considerations in using psychotropic medication with dual diagnosis patients on recovery. J Psychoactive Drugs 21:221–228, 1989.PubMedCrossRefGoogle Scholar
  43. 43.
    Ridgely MS, Goldman HH, et al.: Barrier to the care of persons with dual diagnoses, organizational and financial issues. Schizophrenia Bull 16:123–132, 1990.CrossRefGoogle Scholar
  44. 44.
    Paredes A: Administrative locus in the delivery of services to alcoholics with psychiatric disorders, in Gottheil E, McLellan AT, Druly RA (eds): Substance Abuse and Psychiatric Illnessi New York, Pergamon Press, 1980.Google Scholar
  45. 45.
    Klerman G: The psychiatric patient’s right to effective treatment: implications of the Oshroff vs. Chestnut Lodge. Am J Psychiatry 147:409–418, 1990.PubMedGoogle Scholar
  46. 46.
    Bower GH, Morrow DG: Mental models in narrative comprehension. Science 247:44–48, 1990.PubMedCrossRefGoogle Scholar
  47. 47.
    Bunt G, Galanter M, et al.: Cocaine/“crack” dependence among psychiatric inpatients. Am J Psychiatry 147:1542–1548, 1991.Google Scholar
  48. 48.
    Schneier FR: A review of psychoactive substance use and abuse in schizophrenics. J Nerv Ment Dis 175:641–652, 1987.PubMedCrossRefGoogle Scholar
  49. 49.
    Alterman AI, Erdien FR, McLellan AT: Problem drinking in a psychiatric hospital: alcoholic schizophrenics, in Gottheil E, McLellan AT, Druly RA (eds): Substance Abuse and Psychiatric Illness. New York, Pergamon Press, 1980.Google Scholar
  50. 50.
    Siegel BS: Love, Medicine and Miracles. New York, Harper & Row, 1986.Google Scholar
  51. 51.
    Jung C: Modern Man in Search of a Soul. New York, Harvest/HBJ, 1933.Google Scholar
  52. 52.
    Merton T: The New Man. New York, Noonday Press, 1961.Google Scholar
  53. 53.
    Mahler M: On Human Symbiosis and the Vicissitudes of Individuation. New York, International University Press, 1968.Google Scholar
  54. 54.
    Miller A: The Drama of a Gifted Child. New York, Basic Books, 1968.Google Scholar
  55. 55.
    Winnicott DW: Primary maternal preoccupation, in Collected Papers. New York, Basic Books, 1956.Google Scholar
  56. 56.
    Watts AW: Psychotherapy East and West. New York, Pantheon Books, 1961.Google Scholar
  57. 57.
    Sachs O: The Man Who Mistook His Wife for a Hat. New York, Harper & Row, 1985.Google Scholar
  58. 58.
    Nietzsche F: Thus Spoke Zarathustra. New York, Viking Press, 1966.Google Scholar
  59. 59.
    Finley Y: Merton’s Palace of Nowhere. Notre Dame, IN: Ave Maria Press, 1988.Google Scholar
  60. 60.
    Fromm E: To Have or to Be. New York, Bantam, 1982.Google Scholar
  61. 61.
    Sullivan HS: The Interpersonal Theory of Psychiatry. New York, Norton, 1953.Google Scholar
  62. 62.
    Viscott D: The Language of Feelings. New York, Pocket Books, 1976.Google Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Alina M. McKenna
    • 1
  • Alfonso Paredes
    • 2
  1. 1.Combined Drug and Alcohol Treatment Program, West Los Angeles Veterans Affairs Medical Center, and Department of PsychiatryUniversity of CaliforniaLos AngelesUSA
  2. 2.Substance Abuse Program, West Los Angeles Veterans Affairs Medical Center, and Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA

Personalised recommendations