Introduction. The Challenges of Dual Diagnosis: Managing Substance Abuse in Severe Mental Illness

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The course and treatment of severe mental illness canbe complicated by the co-occurrence of substance use disorders. According to the Epidemiologic CatchmentArea study,¹ 47% of those with schizophrenia and 56% ofthose with any bipolar disorder meet the criteria for substanceabuse or dependence at some point during their life.Patients with the dual diagnosis of substance use andschizophrenia tend to have an earlier age at onset and experiencemore frequent and longer periods of hospitalization,have more depressive and psychotic symptoms, andhave more episodes of suicidal behavior, violence, and legaland financial problems than those who do not use orabuse drugs or alcohol.’ ‹