Dual Disorders - Dual Diagnosis

A dual disorder is the co-occurrence of one or more diseases or disorders in an individual. It is commonly used in mental health and the drug and alcohol field to describe co-occurring mental disorders and the co-occurrence of substance use (alcohol or other drug dependence).

• NSW Government Resources
• Other Australian Resources
• International Resources

NSW Government Resources

NSW Health

1. Interagency Action Plan for Better Mental Health – First Yearly Progress Report
   The Interagency Action Plan for Better Mental Health was developed to ensure that government agencies work more effectively together and with the community to improve care for people with mental illness. The following report provides an overview of whole-of-government achievements against the commitments in the plan after the first year of implementation.
2. NSW: A new direction for Mental Health
   A five-year plan to provide earlier and better access to a greater range of services than has ever been provided by public mental health services in NSW.
3. The Management of People with a co-existing Mental Health and Substance Use Disorder - Discussion Paper
   Developed by the NSW Health Department's Dual Diagnosis Project, to explore the issues and health care needs of people with co-existing mental health and substance use disorders. May 2000
4. The Management of People with a co-existing Mental Health and Substance Use Disorder Service Delivery Guidelines
   Guidelines developed to provide a clear direction for health services to better meet the needs of people with co-existing disorders.The guidelines can be used as a blueprint for services to design, develop and deliver comprehensive health care for people with co-existing disorders. Strategies include the need to build partnerships, improve workforce training and provide a range of interventions aimed towards positive health outcomes.

The Midas Website
Dual Disorders Web Ring
The Dual Disorders Web Ring is a project of the dual diagnosis service of South Western Sydney Area Health Service (SWSAHS) and includes links to programmes in Australia and overseas which are independent of SWSAHS. (A Web Ring is a group of internet sites which share a common theme, interest or philosophy. Each is independent, retaining its own identity and approach.The Ring provides a link which allows anyone who has logged onto a Ring site to move freely between all the member sites.)

NSW Department of Community Services (DOCS)
Parents with dual diagnosis – the impact on children
Information about a research paper which examines the links between child protection reports and incidences of dual diagnosis in parents – a condition that involves both mental illness and substance abuse.

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Other Australian Resources

Council of Australian Governments
10 February 2006
Resolution to reduce the impact on mental health of substance abuse.

Australian Department of Family & Community Services
Barriers to Service Provision for Young People with Presenting Substance Misuse and Mental Health Problems
The report details and describes the barriers to service provision for young people suffering from comorbidity. October 2004 Australian Department of Health and Ageing. Population Health Division

Australian Department of Health and Ageing

1. Alerting the Community to the Link between Illicit Drugs and Mental Illness
   A report on the understanding of the link between illicit drugs and mental illness among Australians.
2. Comorbid mental disorders and substance use disorders: epidemiology, prevention and treatment.
   A report prepared by the National Drug and Alcohol Research Centre (NDARC) that reviews the national and international evidence in respect to comorbid mental health and substance misuse problems. 2003
3. Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders. 2nd ed.
   A review of the screening and diagnostics instruments that may be used to assess concurrent psychiatric or drug and alcohol problems. It also serves as a practical resource for clinicians working within mental health settings, drug and alcohol services, hospitals and general practice. It includes information regarding special populations, specifically Indigenous Australians, older persons and adolescents. August 2002
4. National Comorbidity Project
   The report from a workshop which was held in Canberra in March 2000 to develop a joint agreement on the most appropriate policy approach to comorbidity. The identified priority areas included prevention and early intervention; carers and consumers; research and evaluation; education and training; integration or collaboration between services; and  whole-of-government approaches. March 2001

Australian Institute of Health and Welfare (AIHW)
National Comorbidity Initiative: A Review of Data Collections Relating to People with Coexisting Substance Use and Mental Health Disorders
The National Comorbidity Initiative was established to improve service coordination and treatment outcomes for people with coexisting mental health and substance use disorders. A priority area under this Initiative is to improve data systems and collections methods within the mental health and alcohol and other drug sectors to manage comorbidity more effectively. This project, commissioned by the Australian Government Department of Health and Ageing, identifies, reviews and reports on the current state of data collections relating to people with coexisting substance use and mental health disorders ('comorbidity') in Australia. 2005

The Coffs Harbour Project: A Violence Prevention Program For Substance Misusing Mentally Ill
The Coffs Harbour Project was an Australian Rural Health and Police interagency crime prevention initiative. Its aim was to reduce the reported violence and excessive mental health and police agency use by people with dual disorders. This report is by Adrian Bradley and Barry Toohey. 1999

Eastern Hume Dual Diagnosis Service - Gary Croton
Co-occurring mental health and substance use disorders: An investigation of service system modifications and initiatives designed to provide an integrated treatment response
2004

Flinders University. School of Medicine

1. Detection of comorbidity in general practice
   A brief overview of the literature regarding the detection of coexisting substance use and mental health problems in the general practice practice setting.
2. GP Comorbidity Case Examples
    This page features six diferent comorbidity case examples that demonstrate the use of components of these principles of care.  These cases include details of presentation, detection of comorbidity, assessment, treatment, and outcome.  Keys to the patient's successful treatment and improvement are also outlined. 

National Drug Strategy

1. Comorbidity of mental disorders and substance use in General Practice
   This study includes a comprehensive national and international literature review on best practice for identifying, managing and treating people with comorbid disorders in primary care settings. The study also surveys primary care and general practice in Australia to identify current training and organisational initiatives in respect to comorbidity and identifies gaps in areas such as research, education, training and service support. 2003
2. Comorbidity of mental disorders and substance use: A brief guide for the primary care clinician
   This resource provides a set of principles for the management of people with comorbidity and includes more detailed information about specific aspects of management of people with comorbidity. 2003
3. Current Practice in management of clients with comorbid mental health and sustance use disorders in tertiary care settings
   The first part of this report identifies the scope of current practices in service delivery to clients with comorbid mental health and substance use disorders across Australia. The second part comprises a national audit of education, training and other learning opportunities for those working with clients with comorbid mental health and substance use disorders. 2003
4. The health and psychological effects of cannabis use
   2001

Mental Health Co-ordinating Council (MHCC)

1. Factsheet: Mental Health Issues and Substance Abuse 
2. Mind the Gap: The National Illicit Drug Strategy (NIDS) Project to Improve Support for Children from Families where there are Mental Illness and Substance Abuse (MISA) Issues.
   This paper examines the links between child protection reports and incidences of dual diagnosis in parents. It shows that although there is considerable literature on the effects of either parental mental illness or substance abuse on children, there is a gap in research that targets the dual condition. 2005

Mental Health Council of Australia
Where There’s Smoke – Cannabis and Mental Health

NSW Association for Adolescent Health (NAAH)
Caught in the Gap: Dual Diagnosis and Young People
A report on young people and dual diagnosis. It includes key recommendations to improve the health outcomes of young people with dual diagnosis.

Primary Mental Health Care: Australian Resource Centre Commonwealth of Australia
Comorbidity of mental disorders and substance use: A brief guide for the primary care clinician.
This resource is intended as a simple guide for physicians. 2002

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International Resources

Behavioural Health Recovery Management (BHRM)

1. Service Planning Guidelines: Co-occuring Psychiatric and Substance Disorders
   By Kenneth Minkoff. A look at the research and literature used to formulate guidelines aimed at the assessment, treatment, and psychopharmacology of individuals with co-occurring disorders. March 2001
2. Motivational Enhancement for Dually Diagnosed Consumers
   Guidelines developed to assist those working with people who have been dually diagnosed. October 2001
3. Treatment of PTSD and Substance Abuse
   Substance abuse and posttraumatic stress disorder (PTSD). October 2002

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Co-morbidity - Drug Use and Mental Disorders
A 4 page policy briefing about co-morbidity. 2004

Harvard University
Comprehensive Continuous Integrated System of Care (CCISC):  Psychopharmacology Practice Guidelines for Individuals with Co-occurring Psychiatric and Substance Abuse Disorders (COD)
A research paper by Ken Minkoff. 2005 (PDF 153K)

Health Canada
Summary Report on the Workshop on Best Practices for Concurrent Mental Health and Substance Use Disorders (February 21 and 22, 2002)
Health Canada invited more than 50 professionals working in the fields of mental health and/or substance use treatment to a workshop on Best Practices in Concurrent Mental Health and Substance Use Disorders. This is a report from that Workshop.

National Alliance for the Mentally Ill (NAMI)
Dual Diagnosis: Mental Illness and Substance Abuse: Factsheet

The National Center on Addiction and Substance Abuse, USA:
Family Matters: Substance Abuse and The American Family 
Parents who use illegal drugs, abuse alcohol and use tobacco put half the nation’s children – more than 35 million of them – at greater risk of substance abuse and of physical and mental illnesses. 2005

Resources for Co-occurring Addiction and Personality Disorders
A website with resources specifically devoted to dual disorders including online articles and other documents, training manuals, etc.

Rethink
Dual diagnosis tool kit
This toolkit provides background information to the issues surrounding dual diagnosis and offers a practical guide to delivering services. It includes information about substance misuse, mental health and policy background and features current treatment modules along with case studies and exercises for individuals or group work. 2005

South Carolina State Government
Mental Illness and Substance Use
A brief overview of assessment and treatment issues for clients/patients with mental illness and substance abuse/dependency.

US Government

1. The Link Between Marijuana and Mental Illness: A Survey of Recent Research. 2005
2. Substance Abuse Treatment For Persons With Co-Occurring Disorders: A Treatment Improvement Protocol (TIP 42)
   Best-practice guidelines for the treatment of substance use disorders. 2005
3. Serious Mental Illness and Its Co-Occurrence with Substance Use Disorders, 2002
   This report presents information on the prevalence and treatment of serious mental illness (SMI) and their association with substance use and co-occurring substance use disorders based on the 2002 National Survey on Drug Use and Health (NSDUH). 2004
4. Integrating Substance Abuse Treatment and Vocational Services
   This publication introduces vocational services and resources, and presents clinical issues related to integrating vocational services into a substance abuse treatment plan. It also discusses policy and funding, and a legal chapter explains the recent regulation that affects employment and substance abuse disorder treatment. 2000

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