Dual diagnosis: A treatment model for substance abuse and major mental illness

The treatment of dual diagnosis, co-occurring substance abuse and mental illness, calls for addressing two serious and often confounding problems. The authors introduce an expanded version of the transtheoretical model of change as formulated by J.O. Prochaska and C.C. DiClemente, and suggest that this new version offers a pragmatic approach to the conceptualization and treatment of dual diagnosis. The potential utility of the treatment model is presented through the authors' experiences in working with inner-city, chronic mentally ill individuals with substance abuse problems. Practical guidelines for dual diagnosis group therapy are discussed.Dr. Brady is an assistant research professor at the Boston University School of Medicine and the deputy superintendent for research and training at the Dr. Solomon Carter Fuller Mental Health Center. Drs. Hiam, Saemann, Humbert, Fleming and Brickhouse were senior members of the clinical/administrative staff at the Fuller MHC.