From the Editors

With this issue, we have taken over the helm of the Journal of Dual Diagnosis—devoted to exploring the basis of the co-occurrence of neuropsychiatric and substance use disorders, as well as optimal treatment for those individuals with such co-occurring disorders. We are grateful for the work done by Dr. Peter Buckley and the members of the Journal's Editorial Board over these past 5 years to launch the Journal. We have agreed to become Co-editors on the assumption that, in collaboration with a newly constituted, strong Editorial Board, this Journal can become the premier publication for investigators and clinicians interested in studying and working with those with co-occurring disorders. Four of our close colleagues, Drs. Mary Brunette, Gregory McHugo, Kim Mueser, and Douglas Noordsy, have agreed to serve as Associate Editors, and Stephanie Acquilano, a long-standing colleague at Dartmouth, has signed on as Managing Editor. Working with the publisher, Taylor & Francis, and in consultation with the Editorial Board, we intend to revamp the structure of the Journal and greatly enhance its quality. Our goal is to publish only high-quality articles from the major research and clinical disciplines relevant to the field.

Our interest in this field stems primarily from our work with patients with schizophrenia, who are likely to have substance use disorders—47% of them, according to the 1990 Epidemiological Catchment Area study (Regier et al., 1990). More recent studies have indicated that 44% of all cigarettes in the United States are smoked by individuals with severe mental illness—about 3% of the overall population. What has interested us from the beginning is the fact that substance use disorders do not only occur frequently in patients with schizophrenia; rather, they occur commonly in many other neuropsychiatric disorders as well—in patients with bipolar disorder, posttraumatic stress disorder (PTSD), major depression, and traumatic brain injury.

The co-occurrence of substance use disorder with schizophrenia, in particular, has been puzzling, because for many years the generally accepted understanding in the field, based on commonsense theories, was that substance use was an attempt to simply self-medicate psychiatric symptoms. Depressed people would use stimulants to feel better, and so forth. But, with schizophrenia, at least, that has been very hard to prove. The theory would suggest that substance use in schizophrenia is an attempt to treat negative symptoms. But studies have never been able to confirm this notion—in fact, those with negative symptoms seem to use substances less than those without them.

So, why does it occur?

Is it an effect of lifestyle? Poverty? Friendship groups? Is it an attempt to get some pleasure out of life? Is it due to the lack of ability to inhibit the impulse to use substances? Is it due to a dysregulated brain circuitry that unpins the use?

Is it all of the above?

Unfortunately, the topic of “dual diagnosis” has had only limited scholarly activity. Not enough investigators have tried to address the thorny issue of why these disorders occur so commonly together.

It is hard enough, some say, to address substance use disorders or PTSD—why complicate things by trying to address them together when they overlap?

We anticipate that the articles appearing within the Journal—either regular articles or articles within theme issues—will address the question of etiology from the perspectives of neurobiology, cognitive neuroscience, psychology, and social science. We hope that the Journal will develop the base of scholarly activity that dual diagnosis requires.

In addition, we intend for the Journal to be translational and to also address treatment. Studies of various therapeutic modalities will be welcome, as will studies that attempt to translate etiologic theories into therapeutic strategies. Treatment will be addressed from the perspectives of somatic therapies (psychopharmacology, even neurotherapeutic devices), psychotherapy, behavior therapy, and societal change. Research related to optimal treatment is needed for the development of best practices.

Too often, the disorders are treated separately, even by different groups of clinicians. But our contention is that these disorders coalesce for a reason and that the treatment, to be effective, has to address both disorders at the same time and by the same group of clinicians. We welcome articles that contradict that statement as well as those based on it.

Our goal is to stimulate debate that begins to hone in on a better understanding of the basis of and optimal treatment for these co-occurring disorders.

We welcome unsolicited manuscripts, which will be carefully but quickly reviewed. Authors will learn quickly whether or not their manuscript is acceptable for publication—either as is or with modification. We will be delineating theme issues as well, with guest editors. We welcome suggestions from readers about particular theme issue topics.

We look forward to building a first-rate Journal. We solicit your feedback and suggestions.

DISCLOSURES

Dr. Green reports research grant support from Janssen and Eli Lilly. He also serves on a Data Safety Monitoring Board reviewing Eli Lilly studies, owns shares of stock in Johnson & Johnson, Pfizer, and Mylan, and has two pending patents on the treatment of substance abuse. Dr. Drake reports no financial relationships with commercial interests.