INDIVIDUALS DIAGNOSED WITH BOTH SCHIZOPHRENIA AND SUBSTANCE ABUSE: SYSTEM MISFITS

摘要

This presentation will examine system barriers to the assessment and treatment ofrnindividuals diagnosed with both schizophrenia and substance abuse. Factors contributingrnto system barriers include separate funding streams, conflicting ‘directives’ emanatingrnfrom the medical and ecological models, narrow views of assessment, disparate views ofrntreatment by substance abuse and mental health communities, lack of cross training,rnbiased notions of the dually diagnosed, as well as conflicting treatment expectations andrngoals --- all of which are further reinforced by poor treatment responses. The result forrnthe dually diagnosed is a self-defeating spiral intensifying their system misfit status andrntheir failure in treatment, evidenced by homelessness, criminal and suicidal behaviors,rnand increased risks of HIV infection, medical illness, and early mortality. Although dualrndiagnosis has been recognized as a major mental health problem in the United States,rnwith substance abuse becoming so prevalent among the mentally ill that its use isrnassumed, treatment of the dually diagnosed has come to be viewed as a ‘missionrnimpossible’. Suggestions to overcome obstacles to assessment and treatment of therndually diagnosed will be outlined, emphasizing the need for specific systemrnmodifications.