The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 1 CME credit.
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Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes than those with either disorder in isolation. And these patients are far from rare.
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Despite an increased awareness of co-occurring disorders, there remains a fair amount of confusion about how to treat a mental health issue and a substance abuse issue at the same time without causing more harm. To further complicate the issue, when patients first walk in you often don’t know whether they are dealing with two conditions concurrently. Charles Atkins’ book, Co-Occurring Disorders: Integrated Assessment and Treatment of Substance Use and Mental Disorders, addresses these problems. We turned to him for some practical guidance.
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Although studies have demonstrated the effectiveness of contingency management (CM) for illicit drug use, there’s less evidence for treatment of alcoholism—in part because a standard breathalyzer has a short detection window of 12 hours, meaning patients must only abstain from drinking since the previous night to pass the test.
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Dr. Capurso is the Assistant Director of Addiction Services at Connecticut Valley Hospital and an associate clinical professor of psychiatry at the Yale University School of Medicine. Prior to joining Connecticut Valley Hospital, he was the medical director of the Detoxification & Addiction Stabilization Service and the Psychosocial Residential Rehabilitation Program at the West Haven Veterans Administration Hospital. He completed medical school, psychiatry residency, and addiction psychiatry fellowship at Yale.
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