Dual Diagnosis: An Integrated Approach to Treatment

Amid several recently published books on integrated treatment for persons with co-occurring mental illness and substance use disorders, or dual diagnosis, this small volume aims for a unique niche: the health care professional early in training as a student. The authors are all academic social workers, and together they bring a wealth of clinical, supervisory, and teaching experience to the task.

Compared with other recent books of the genre, this contribution has a number of strengths. As opposed to edited volumes, it has a consistent style and quality. The authors provide realistic examples and address them in the context of three relevant perspectives: the biopsychosocial model, a problem-solving approach, and a stage-wise approach to behavioral change. The major psychiatric diagnoses are discussed in separate chapters that begin with basic definitions and progress to provide clinically rich comments.

Consistent with the authors' backgrounds, the book emphasizes the importance of interdisciplinary approaches, of working with clients' strengths and environments rather than overemphasizing psychopathology, and of attending to cultural issues. My favorite aspect of the book is the modest clinical wisdom that inheres in each chapter. These authors clearly understand that recovery from dual disorders is a complicated journey that requires time, courage, personal growth, and appreciation of individual and environmental diversity. Clients need supports, skills, and guidance throughout the journey, and these authors are clinician-guides who respect both the process and the travelers.

The book also has a few weaknesses. Minimal attention is given to research, and no real differentiation is made between guidelines that are evidence based and those that are based on clinical wisdom or theory. There is also minimal coverage of pharmacological interventions and essentially no attention to the medical consequences of the use of alcohol and other drugs. These problems probably diminish the book's appropriateness for clinical researchers and for psychiatrists in training.

Nevertheless, students aiming toward careers in case management, counseling, or social work will find this an exciting introduction to a rich and rapidly developing field. They will not find a better balance of basic information, excellent clinical material, and well-articulated theory.