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Is Current Dual Diagnosis Research Sufficient?

This issue of the Journal contains a broad range of studies that comprise dual diagnosis research: epidemiology, path analysis, cohort studies, surveys of caregiver attitudes, small controlled trials, and analyses of administrative databases. Only basic neuroscience is missing. While the breadth of current work is impressive, we still need to ask whether the current approaches to dual diagnosis research will be sufficient to make the progress we need. But before we address this question, let us introduce the studies. Using epidemiologic data from the National Epidemiologic Survey on Alcohol and Related Conditions, Pacek, Storr, Mojtabai, Green, La Flair, Alvanzo, Cullen, and Crum examined the onset of alcohol use disorder and several types of anxiety disorders. Their findings of some specificity in terms of the temporal relationships are intriguing, but the authors understand well that specifying causality on the basis of timing of onset is speculative. For example, nicotine addiction usually precedes the overt onset of schizophrenia due, most likely, to the natural course of both illnesses rather than to a causal relationship. Temporal relationship is only one of several criteria that Bradford Hill used years ago to confirm the relationship between smoking and lung cancer. Further, designating “major” or “primary” disorders in the face of comorbidity is also fraught with difficulties. For example, alcoholism develops in many people after a major trauma leads to posttraumatic stress disorder, but the disorders become so intertwined that considering them both major and treating them concurrently is practical and effective.