Abstract
Objectives: The aim of this study was to describe associations between psychiatric and substance use disorders that had been referred to a newly established Dual Diagnosis (DD) Program from a Drug Treatment Service (DTS), Community Mental Health Teams (CMHT), and an Inpatient Service within a regional Mental Health Service.
Methods: Clinical measurements were obtained over a 10-month interval, from March to December 1999. Psychiatric and Substance Use diagnostic groups, level of Abuse/Dependency, stage of treatment and potential outcome measurements were recorded. Instruments used were personal psychiatric interview, Clinician Rating Scale (CRS), Substance abuse and Treatment Scale (SATS), Health of the Nation Outcome Scale (HoNOS) and Life Skills Profile (LSP).
Results: 65 subjects, predominately males, with significant disability, as measured by HoNOS and LSP, are described. The psychiatric diagnoses fell into 5 groups; Psychotic Disorders, Mood and Anxiety Disorders, DSM1V Axis 11 Disorders, Mixed Mood and Anxiety plus Axis 11 Disorders, and Organic Disorders. There was a strong association between psychotic and cannabis use. Within the DTS setting 52% of the diagnoses were mood and anxiety related. However Psychotic Disorder was diagnosed in 12% of these DTS subjects. Poly-substance (PSU), opiate and alcohol use predominated the inpatient setting. Alcohol Abuse/Dependency was seen in 50% of the Mood and Anxiety plus Axis 11 Disorder group. PSU the greatest in the DTS setting, present in 100% of the CMHT referrals with a Axis 11 disorder, and seen in 60% of the psychotic disorder group in the DTS setting. The ratio of Abuse to Dependence was greatest in the CMHT setting. Overall 30–40% of DD subjects were not engaged in any significant management of their drug and alcohol issues, as measured by the SATS. 80–90% of the referrals appeared able to be managed in the initial referral site with DD assistance.
Discussion: These results have significant service delivery issues for the regional Mental Health Service.