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• W2007142053 abstract "The public health emergency of AIDS underlines the growing need for more medical treatment of substanceabuse-related disorders. Across-culture treatment of drug abuse has been found consistently to be a principal determinant in the prevention of the spread of AIDS. Furthermore, a galling limitation of AIDS prevention interventions is the prevalence of psychopathology in the target population, which curbs the effectiveness of services. Substanceabuse disorders have grown in medical importance and are now a focus for progress in psychiatry. However, progress in diagnosis is not reflected in treatment protocols. Treatment is often triaged to professions without the training to make a psychiatric diagnosis and effective clinical decisions:1Wheeler J Fadel H D'Aunno T Ownership and performance of outpatient substance abuse treatment centers.Am J Pub Hea. 1992; 82: 711-717Crossref PubMed Scopus (53) Google Scholar sympathy is scant for a person with a perceived self-inflicted disease. It turns to aversion if that person refused to conform to the patient role and comes from socially excluded populations. Substance abuse is life-threatening, but it has favourable recovery rates after treatment. Without intervention a progressive disease is often fatal. Patients drop out of treatment for many reasons. The lack of adequate psychiatric services to help the patient to cope with an underlying psychopathology needs to be addressed. In the Netherlands, clinical management of patients with a dual diagnosis of substance-related disorder and another psychiatric illness has become a priority because proposals for new treatments such as heroin maintenance are being planned. The addiction severity index (ASI), first validated in Europe on a Dutch addict population, showed high levels of psychopathology.2Hendriks VM Kaplan ChD Limbeek JV van Geerlings P The Addiction Severity Index: reliability and validity in a Dutch addict population.J Subst Abuse Treat. 1989; 6: 131-141Summary Full Text PDF Scopus (199) Google Scholar Estimates by the Dutch National Council of Public Health indicate that 40–70% of the drug-using population show evidence of psychopathology in addition to substance-abuse diagnosis. In studies in home and clinical settings that use intensive time-sampling techniques, the daily lives of such people are characterised by hidden, undiagnosed psychopathology, detectable in mood disorders and craving behaviour.3deVries MW Kaplan ChD Dijkman-Caes CIM Blanche P The experience of drug craving in daily life.in: Platt JJ Kaplan ChD McKim PJ The effectiveness of drug abuse treatment: Dutch and American perspectives. Robert E Krieger Publishing Company, Malabar, Florida1990: 127-147Google Scholar The Amsterdam morphine dispensing programme showed that 41% of individuals presented with schizophrenia, or psychotic and affective disorders.4Derks J. The Amsterdam Morphine Dispensing Programme. A longitudinal study of extremely problematic drug addicts in an experimental public health programme. NcGv-series, no 90–3, Utrecht, the Netherlands, 1990: 395.Google Scholar Personality disorder was diagnosed in 35% of the remaining group (49% of the total sample), ranging from schizotypal to antisocial types. In only 20% of the group could no diagnosis be made by experienced clinicians. The conclusion was that psychopathology greatly influenced outcome, clearly pointing to the need for intensified psychiatric evaluation and care in the targeted population. We now have the means and knowledge to meet this challenge to psychiatry. The provision of family therapy, psychiatric treatment, and didactic workshops have proven effective in methodone-maintenance programmes.5McLellan ATh Arndt IO Metzger DS Woody GE O'Brien ChP The effects of psychosocial services in substance abuse treatment.JAMA. 1993; 269: 1953-1959Crossref PubMed Scopus (746) Google Scholar Much improvement was shown in the attentuation of drug use and psychopathology. These positive outcomes were attributable to standard psychiatric interventions. The introduction of psychiatric services may seem overly expensive, but the experience of managed care in the USA has proved that psychiatric treatment of drug-addicted patients can be done cost-effectively. Success involves organising social psychiatric services in a network of referral and screening that includes other professionals. To help finance these necessary psychiatric services, evaluation needs to be done, as it is for pharmacological and other medical interventions." @default.
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• W2007142053 date "1997-03-01" @default.
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• W2007142053 title "Psychiatric diagnosis in addiction treatment experiments" @default.
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• W2007142053 doi "https://doi.org/10.1016/s0140-6736(05)61611-x" @default.
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