Treating Dual Diagnosis Patients: Challenges and Opportunities

R. Howland
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引用次数: 3

Abstract

T he use and abuse of drugs and alc ohol ha ve recently gained grea ter attention both from the public and the medical profession . Desp ite increasing cognizance of its un fo r tunate consequences, substance use has become a more pervasive element of conte mporary society. As substance abuse ha s come to affect more segments of the population, it is not surprising that this problem a lso has affected the mentally ill. Awareness of the mentally ill subs ta nce ab user ha s grown , a lthough this population has not been well studied or well served by th e mental health system . These dually diagnosed patients often a re depict ed as the square pegs of psychiatry, not quite fitting into the round hol e of menta l health treatment. The reason for this is clear. Because of the curren t structure of th e mental health service delivery syste m , psychiatric and subs tance abuse services are provided almost exclusivel y by independent syste ms (1 ,2). As a result , those patients who are perhaps most in need of treatment are most likel y to fall through the cracks of the system. Providing services for this group of patients represents a clinical and administrative challenge, wh ich has no t bee n adequately addressed by the psychiatric profession . In this paper, I suggest that psychiatrists can accept greater responsibility for working with th e d ually di agnosed , and that this responsibility could begin with th e psych iatrist-i n-tra in ing. Although the prob lem may be difficult to overcome, psychiatry is in a unique position to accept this responsibility, effect changes in th e syste m , and have a positive impact on the lives of patients with dual diagnoses.
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治疗双重诊断患者:挑战与机遇
最近,毒品和酒精的使用和滥用受到了公众和医学界更大的关注。尽管人们越来越认识到药物使用的不良后果,但它已成为当代社会中一个更加普遍的因素。由于药物滥用已经影响到更多的人群,所以这个问题也影响到精神病患者也就不足为奇了。随着用户的增加,人们对精神疾病的认识也在增加,尽管这一人群并没有得到很好的研究,也没有得到心理健康系统的良好服务。这些双重诊断的患者经常被重新描述为精神病学的方形钉子,不太适合精神健康治疗的圆形瓶子。原因很清楚。由于目前精神卫生服务提供系统的结构,精神科和药物滥用服务几乎完全由独立系统提供(1,2)。因此,那些可能最需要治疗的病人最有可能从系统的裂缝中掉出来。为这群病人提供服务是一项临床和管理上的挑战,精神科专业尚未充分解决这一问题。在这篇论文中,我建议精神科医生可以承担更大的责任,与最终确诊的患者一起工作,而这种责任可以从精神科医生的培训开始。虽然这个问题可能很难克服,但精神病学处于一个独特的位置,可以承担这一责任,影响医疗体系的变化,并对双重诊断患者的生活产生积极影响。
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