Abstract
Dual diagnosis or comorbidity, fact or artifact? The general descriptive term used for people who have both a mental disorder and substance use problem is debated, as is the importance of such a label. The authors or publishers of this book have settled on dual diagnosis which will immediately offend those who dislike the term, or those who are repelled by a label or prefer to use comorbidity as their shorthand for this ubiquitous patient group. However, the breadth, coverage and range of viewpoints covered in this very readable book will extinguish such potential disquiet. If you were in doubt as to the importance of dual diagnosis, you are reminded a number of times in the early chapters that there is growing awareness and interest in the area, a dearth of evidence about what works in treatment and a number of theories to account for the common association of substance misuse and other psychiatric disorders.
The 17 contributors are from various backgrounds such as psychiatry, administration, psychology, forensic psychology, policy analysis/social work, addiction nursing, public health and addiction academia. I enjoyed the diversity of views reflected by the variety of authors. The perspective is dominantly English although in an interesting chapter, covering ‘European Dimensions’ (i.e. Europe outside the UK) the Italian approaches are outlined. Given the book's regional focus, there is only fleeting reference to the Australian or New Zealand perspective and citations for only a handful of local authors, (e.g. Pols, Siegfried, Hall and Kavanagh). The well-known and frequently quoted epidemiological literature was referred to with some irritating repetition in the chapters in the first half of the book. This irritation was all the more caustic as there was no reference to the Australian Bureau of Statistics National Survey of Mental Health and Wellbeing [1], a large and well designed epidemiological study with good data on the type of ‘comorbidity’ that the book covers.
As with any book with a number of contributors, the appeal of the chapters varied. However, apart from ‘Complex behaviour’, a chapter I found very difficult to read, they were of a good standard. ‘The challenge of shared care’, which focused on service issues (normally a somewhat dry subject) was outstanding and succinct. A brief outline of practical approaches was well covered in ‘Treatment strategies and interventions’. ‘Dual or separate services’ summarized the debate on this issue and other approaches such as the liaison or collaborative model that has been reported in the journals.
A lot of literature on dual diagnosis has been published. What I particularly liked in this book was seeing it referred to in the one accessible source. Have you ever wondered how your service could change to better address the problems faced by these patients? Which book to suggest to your mental health team as a reference for the area? What changes are needed in undergraduate curriculae to enhance the overall care of this clinical population? Or have you ever pondered what more can you individually do to treat these patients? Or have you ever thought, ‘what is all the fuss about dual diagnosis anyway?’ If so, you will find this a useful book.