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The Challenge of Dual Diagnosis

AYOUNG man, let's call him James, had a history of mental illness and alcohol abuse. A friend of mine, a recovering alcoholic, told me that his first encounter with James was at a local Alcoholics Anonymous (AA) group. James had been directed to AA by the psychiatrist at a community mental health center. When James shared with the AA group that he was taking medication for his mental illness, he was told that in order to recover from alcoholism he must abstain from any and all mood-altering drugs. Several meetings later, James said that his doctor insisted that he remain on his medication. For months, James struggled to reconcile his doctor's orders with the rules of AA. Then, suddenly, he no longer appeared at meetings. One day my friend was visiting the Middle Tennessee Mental Health Institute, and there was James, who was now a patient at the hospital. My friend wondered, "Did this young man wind up in a mental institution because the alcoholic support group didn'tknow how, or were unwilling, to deal with his mental illness, or was it because the mental health treatment people didn't know how or were unwilling to deal with his alcoholism?" The case of James raises the subject of dual diagnosis. Now be it understood that I claim no substantial expertise in dual diagnosis. I am an administrator, not a clinician. However, as the Commissioner of the Department of Mental Health and Mental Retardation, the subject of dual diagnosis gives me cause for concern. I have become aware of the prevalence of dual diagnosis, the complications it poses to effective treatment, the difficulties confronting clients in seeking treatment, and the substantial costs that patients with dual diagnosis contribute to the health care system.