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On Silos, Moieties, and Health Care Reform

Contributions to the Journal continue to develop and refine knowledge regarding the phenomenology, assessment, and treatment of dual diagnosis, broadly defined as co-occurring mental illnesses and addictive disorders. How this knowledge becomes integrated will influence how health care reform is implemented in the U.S. We will examine the future and health care reform in an upcoming issue. For now, the fundamental structural problem of treatment silos limits all current efforts by reinforcing rigid views of categorical illnesses, simplistic notions of homeostasis, and the non-integrated treatment approaches of professional tribes. Research suffers as well. The current scientific model of human functioning is of course allosteric, meaning that a perturbation of one body system induces widespread responses in others, and holistic, meaning that environmental, social, and psychological mechanisms interact complexly with biology. This issue of the Journal addresses several specific aspects of this complexity. In a very preliminary investigation, O’Hare and Shen suggest that personal motives might shed light on how people with dual diagnoses select specific drugs of abuse and subsequently on treatment. This line of investigation runs counter to research showing that drug choice changes over time and is more typically influenced by access and economic factors than by motives and choices. The burden of proof will be on motivational researchers to control for such factors. Using qualitative methods, Nawaz, Frounfelker, Ferron, Carpenter-Song, Davis, and Brunette show that smoking cessation interventions for clients with dual diagnoses will need to appreciate their cultures and social networks, which