Managing the Dually Diagnosed Patient

David F O'Connell, Eileen P Beyer

About the Editors
Contributors
Foreword
Preface to the Second Edition
Section I: Theoretical and Programmatic Issues
Chapter 1. Managing Psychiatric Comorbidity in Inpatient Addictions Treatment
Clinical Management Policy and Procedure Guidelines
Assessment
Clinical Management and Treatment of Coexisting Psychiatric Disorders in Inpatient Addictions Treatment
Appendix: Clinical Protocols for the Treatment of Selected Psychiatric Disorders
Chapter 2. Improving Treatment Adherence Among Patients with Comorbid Psychiatric and Substance Use Disorders
Introduction and Overview
The Problem of Poor Treatment Adherence
Determinants of Treatment Adherence
Effects of Poor Adherence
Strategies That Improve Adherence
Systems Strategies to Improve Adherence
Conclusions and Recommendations
Suggested Patient Educational Videos
Chapter 3. Psychopathology and Substance Abuse: A Psychoanalytic Perspective
Libido and Personality Development
Early versus Later Psychoanalytic Thought
The Borderline Personality
A Few Nonanalytic Ideas
Comments
Implications of the Theory for the Nonanalytic Clinician
Glossary
Section II: Treatment Considerations with Special Populations
Chapter 4. Females with Dual Diagnoses: Implications for Specialized Clinical Approaches
Introduction
Gender Differences in Addiction
Context of Comorbidity: Relational Perspective
Gender Differences and Similarities in Psychiatric Comorbidity
Major Psychiatric Comorbidities in Addicted Women: Depression, Dissociative Disorders, and Eating Disorders
Need for Specialized Women’s Treatment
Summary of Implications for Specialized Treatment Approaches
Chapter 5. Assessing and Treating Psychiatric Comorbidity in Chemically Dependent Adolescents
Literature Review
Assessment
Treatment
Conduct Disorder
Attention Deficit Hyperactivity Disorder
Mood Disorders
Anxiety Disorders
Conclusions
Appendix: Selected Treatment Protocols for Comorbid Disorders
Section III: Assessment and Treatment of Major Mental Disorders
Chapter 6. A Guide to the Assessment of Psychiatric Symptoms in the Addictions Treatment Setting
Introduction: Current Symptoms and Behaviors As a Guide to Addictions Treatment Planning
A Decision Tree for Assessing Psychiatric Symptoms in the Chemically Dependent Individual
Other Factors to Consider in Assessing the Mentally Ill Substance Abuser
Conclusion
Chapter 7. Affective Disorders and Affective Symptoms in Alcoholism
Alcoholism: More Often the Cause or the Result of Depression?
Incidence of Major Depression in Alcoholics
Prevalence of Major Depression in Alcoholics
Economics
Types of Depression
Diagnosis of Affective Disorder in Alcoholism
The Relationship Between Alcoholism and Affective Disorders
Familial Transmission of Alcoholism and Affective Disorders
Genetic Relationship Between Alcoholism and Affective Disorders
Cerebrospinal Fluid
Dexamethasone Suppression Test
Suicide in Depressed Alcoholics
Remission of Alcoholism and Affective Symptoms
Persistence of Affective Disorders in Alcoholism
Drinking Outcome in Affective Disorder
Pharmacological Treatment of Alcohol Dependence
Treatment Strategies for Affective Disorder in Alcoholism
Conclusion: Summary and Treatment Protocols
Chapter 8. Chemical Addictions and Anxiety Disorders: When Adaptive Mechanisms Go Awry
Introduction
The Disease of Addiction
Anxiety and Anxiety Disorders
Comorbidity
The Interaction
Diagnostic Considerations
Conclusion
Chapter 9. Schizophrenia and Substance Abuse
Introduction
Prevalence of Combined Schizophrenia and Substance Abuse
Schizophrenia
The Effect of Schizophrenia in the Subst