Dual diagnosis: what does it mean?

Abstract

Background: The term ‘dual diagnosis’, referring to co-existing mental health and substance use problems, has recently increased in importance as reflected by the establishment of three new journals. However, several authors have criticised the term and some have proposed alternative terms.

Aims: In this article we provide an alternate viewpoint to an existing detailed criticism of the term by Velleman and Baker (2008). In order to highlight some difficulties with the term, we undertook a preliminary analysis of citations linked to the ‘dual diagnosis’ subject heading.

Method: We searched Medline (1950–2009) using the ‘dual diagnosis’ subject heading and with ‘dual diagnosis’ as a text word. We limited this subset to reviews from 2008 to 2009 and combined it with randomised controlled trials (2008–2009) as a subject heading and notated the topic of each citation.

Results: There were 2609 citations located from 1950 to 2009, increasing gradually until the last two years, during which there has been a decline. An analysis of topics of reviews and randomised controlled trials showed a heterogeneous mix of topics over a wide variety of disparate areas.

Conclusions: We conclude that more specific terms for this patient group have advantages over ‘dual diagnosis’ and other similarly general terms in order to improve clarity in evidence-based clinical practice and research.

Keywords:

• dual diagnosis
• substance use
• psychosis

Acknowledgements

Dr Smith received a Special Training Fellowship from the New South Wales Institute of Psychiatry.