Drafting a dual diagnosis program: a tailored intervention for patients with complex clinical needs

Abstract

Background: Clinical practice of mental health services changed in 1978 after the Basaglia Law was passed, and it is now characterized by usually voluntary treatments offered by community-based services. That broadened the interventions’ focus from the single subject to their environment. Dual diagnosis is defined by WHO as «the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder». It is considered to be a “border territory” since entails networking between different medical services.

Materials and methods: A literature search was performed in PubMed, Web of Science, Scopus and Google Scholar. Search terms were: “guidelines”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “psychiatric illness”, “outpatient”, “inpatient”, “health care service”, “clinical practice”. National and regional regulations about health and addiction were screened too. Out of 598 titles, 31 studies were included in this article for their relevance on treatments and networking between services for dual diagnosis cases.

Results: There are not any guidelines for clinical practice in the literature, neither there are any shared treatment strategies on a national level. Considering the autonomy that every regional health service has, several different courses of action are possible. Here there are reported the ones available.

Conclusions: After discussing the weak points of the treatment options, we suggest the “Multidisciplinary Healthcare” model to best address the difficulties represented by dual diagnosis cases.