When dual diagnosis means no diagnosis: co-occurring mental illness and problematic drug use in clients of alcohol and drug services in eastern metropolitan Melbourne

Abstract

Background: Most previous studies examining the prevalence of co-occurring psychiatric illness and problematic substance use in Australia have been population studies or focused on clients of psychiatric services. There is little literature on the prevalence of psychiatric disorders in persons attending Alcohol and Drug Services (ADS).

Aims: This study attempted to estimate the incidence of mental health disorders in people treated at two ADS in Melbourne and to describe the mental disorders with which they present.

Method: 165 client records from two ADS were reviewed to determine the incidence and characteristics of psychiatric problems in people presenting for management of substance use.

Results: Psychiatric diagnoses were recorded in 42% of client records but rarely substantiated by further documentation. The most common diagnoses were mood disorders (31.5%). Only 4.9% clients were diagnosed with drug-induced psychosis. Personality disorders were not recorded. While 52.7% of clients were documented as receiving psychotropic medication (other than benzodiazepines), 29.3% of those had no documentation of a psychiatric diagnosis. Twenty-three per cent of clients had documented involvement with a Psychiatric Service.

Conclusion: An overall prevalence of 60% could be inferred by combining indicators from the records. Previous studies have suggested that recording of substance use in psychiatric histories is notoriously poor. This study indicates that the reverse is true, that is, psychiatric problems are poorly documented in ADS histories. Thus, the true prevalence of the problem is likely to be significantly underestimated.

Keywords:

• alcohol
• co-morbidity
• drug
• dual diagnosis
• mental illness
• substance use

Acknowledgements

We wish to acknowledge the support and encouragement we received from the staff of the Maroondah Addictions Recovery Project and ACCESS Alcohol and Drug Services.