Dual Diagnosis Of Mental Illness Research Articles

Prevalence of a dual diagnosis of mental illness and substance use disorder in Ontario, Canada: a retrospective cohort study using linked administrative data

ObjectivePopulation-based prevalence estimates of co-occurring mental illness and substance use disorder (herein dual diagnosis) are scarce and derived from a single source (e.g., survey data) which may lead to underestimation of prevalence. We linked administrative data to a representative mental health survey in Ontario, Canada to estimate dual diagnosis prevalence using a data triangulation method. Approach We retrospectively linked the 2002 and 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) to emergency department, inpatient hospital, and outpatient physician records in Ontario, Canada. Mental illness and substance use disorder were ascertained though self-report, Composite International Diagnostic Interview screening, and linked administrative health records. We estimated 1-year, 5-year, and lifetime prevalence of dual diagnosis. ResultsOf the CCHS-MH survey participants, 14,790 (99.8%) were included in the study. The 1-year, 5-year, and lifetime prevalence of dual diagnosis was 2.3%, 4.8%, and 9.8%, respectively, which attenuated to 2.1%, 4.1%, and 8.4%, respectively, when tobacco use disorder was removed from substance use disorder ascertainment. ConclusionDual diagnosis is more common in the general population than previously estimated. Considering barriers to accessing care for both mental illness and substance use disorders among people with dual diagnosis annually, our 5-year prevalence estimate is likely most informative for health system planning. ImplicationsIn the context of increased health burden, barriers to care access, and challenges to effective treatment associated with dual diagnosis, our findings present a case for increased investment in integrated models of mental healthcare and addiction medicine.

Alcohol Screening on Admission to an Acute Mental Health Ward

AimsAlcohol misuse is estimated to cost the NHS £3.5 billion/year. Only 6% of people suffering from alcohol dependence in England, receive treatment per year, highlighting that alcohol misuse is under-identified. During the COVID-19 pandemic, people have significantly changed their drinking habits, evidenced by government tax receipt data, suggesting alcohol sales increased by 3% to 5% in the UK compared to 2019. Problems associated with harmful alcohol consumption were intensified by the crisis, even though the long-term impacts of COVID-19 on alcohol consumption are uncertain. There was a notable increase of patients with dual diagnosis of mental illness and alcohol misuse on our ward, which is a general adult inpatient psychiatric ward. As such, the aim was to assess and improve alcohol screening on admission to an acute mental health ward.MethodsThrough a System One review, we assessed whether alcohol consumption is documented on admission (within 72 hours) in units, and a validated screening tool is used (AUDIT-C), which was expected in all patients. Their notes were initially retrospectively analysed and subsequently reviewed approximately six weeks following the implementation of interventions.Interventions included presenting the findings of the primary survey to our colleagues during a multidisciplinary team meeting on the ward and a trust-wide audit meeting attended by both junior and senior doctors. Additional interventions included posters outlining the importance of alcohol screening in the interview rooms of the acute wards (including a QR code link to our presentation and findings).ResultsOut of the 17 patients on the ward, 47% (8/17) were not appropriately screened for alcohol misuse during their first 72 hours of admission. 47% (8/17) had no documented alcohol history on admission clerking. Only 12% (2/17) had partially quantifiable alcohol intake, both drinking above the recommended weekly amount. None of the ‘Current Drinker’ patients had AUDIT-C screening. Improvement was noted following the interventions during the secondary survey.ConclusionAlthough alcohol screening in acute psychiatric admissions is often vague or incomplete, simple reminders and education can improve screening. If the alcohol history cannot be obtained from the patient on admission, which is often the case, the clinician should clearly document review of notes for historical alcohol use, to avoid potential complications, such as alcohol withdrawal, delirium tremens or seizures.This project raises further questions on how effective brief interventions for excessive alcohol consumption in acutely unwell/psychotic patients are, encouraging a further area of research.

Non-fatal drug overdose after release from prison: A prospective data linkage study

BackgroundAdults released from prison are at increased risk of poor health outcomes and preventable mortality, including from overdose. Non-fatal overdose (NFOD) is a strong predictor of future overdose and associated with considerable morbidity. This study aims to the determine the incidence, predictors and clinical characteristics of NFOD following release from prison. MethodsWe used pre-release interview data collected for a randomised controlled trial in 2008–2010, and linked person-level, state-wide ambulance, emergency department, and hospital records, from a representative sample of 1307 adults incarcerated in Queensland, Australia. The incidence of NFOD following release from prison was calculated. A multivariate Andersen-Gill model was used to identify demographic, health, social, and criminal justice predictors of NFOD. ResultsThe crude incidence rate (IR) of NFOD was 47.6 (95%CI 41.1–55.0) per 1000 person-years and was highest in the first 14 days after release from prison (IR = 296 per 1000 person-years, 95%CI 206–426). In multivariate analyses, NFOD after release from prison was positively associated with a recent history of substance use disorder (SUD), dual diagnosis of mental illness and SUD, lifetime history of injecting drug use, lifetime history of NFOD, being dispensed benzodiazepines after release, a shorter index incarceration, and low perceived social support. The risk of NFOD was lower for people with high-risk alcohol use and while incarcerated. ConclusionsAdults released from prison are at high risk of non-fatal overdose, particularly in the first 14 days after release. Providing coordinated transitional care between prison and the community is likely critical to reduce the risk of overdose.

Switzerland Halts War on Drugs, Cuts Deaths

Switzerland Halts War on Drugs, Cuts Deaths

Research round-up

The effects of co-occurring mental illness and substance use disorder on injury in recently released prisoners is highlighted in a study by Young and colleagues. Researchers analysed data for 1307 adults (median follow-up 495 days [IQR 163–958]) released from prison in Queensland, Australia. The crude rate for hospital contact for injury was 996 per 1000 person-years (95% CI 893–1112) in individuals with co-occurring mental illness and substance use disorder compared with 275 (247–307) in individuals with no mental illness. Relative to recently released prisoners without mental illness, individuals with both mental illness and substance use disorder had increased risk for injury (adjusted hazard rate ratio 3·27, 95% CI 2·30–4·64; p<0·0001), as did individuals with mental illness alone (1·87, 1·19–2·95; p=0·0071). Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort studyPeople released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. Full-Text PDF Open Access

Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study

People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison. Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years) in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation. In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163-958). The crude injury rates were 996 (95% CI 893-1112) per 1000 person-years for the dual diagnosis group, 538 (441-657) per 1000 person-years for the mental illness only group, 413 (354-482) per 1000 person-years for the substance use disorder only group, and 275 (247-307) per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30-4·64; p<0·0001) and mental illness only (1·87, 1·19-2·95; p=0·0071) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders. People released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted. National Health and Medical Research Council.

Qualitative examination of rural service provision to persons with concurrent developmental and mental health challenges

Although there has been an international trend away from institutionalization to community-based care, this has not always been successful, particularly for the unique and vulnerable population diagnosed with both mental health and developmental disabilities. The challenge of meeting the needs of this population is increased in rural and remote areas. As a part of a larger study, this paper reports on the voices of service providers for people dually diagnosed as they maneuver through the considerable challenges of meeting complex needs while located in remote northern communities. The complexities of rural service provision for those with a dual diagnosis of mental illness and developmental disability is also highlighted and includes challenges of northern living, difficulties in diagnosis, and system level issues. This paper confronts the inequities in provision of effective community-based services to this population and draws attention to the need to support and develop local, integrated services in order to build inclusive communities for all.

Physical Status in Psychiatric Patients with Substance Abuse

Introduction People who have a dual diagnosis of mental illness and co-morbid substance use face a challenge in maintaining their physical health as the effects of substance use compound the physical health issues associated with severe mental illness. So physical conditions in patients with dual diagnosis are one of the most important challenges in treatment of these patients. Objectives and Aims This cross sectional analytical-descriptive study aimed to evaluate the physical status of psychiatric patients with the history of substance abuse. Method 263 psychiatric patients which referred to Razi Psychiatric Center of Tehran Iran in 2012-2013 were examined for physical health condition. This examination performed using physical examination, lab tests and Para clinical tests. Results findings showed more than half of psychiatric patients had substance abuse (57.41%). Male patients significantly abused more alcohol and narcotics than females (p Conclusion Regarding to the high prevalence of physical problems in psychiatric patients with substance abuse, it seems that the physical condition of them should be noticed as one of the priorities in clinical programs for this vulnerable group.

Dual Diagnosis Discourse in Victoria Australia: The Responsiveness of Mental Health Services

Objective: In recent decades, psychiatric services have been challenged to be more responsive to patients’ coexisting problems, in particular those concerning substance use. In Australia this has been referred to as a “No Wrong Door” approach. This paper explores the meanings of this move for the acute mental health sector, including attitudes toward a No Wrong Door approach to people with a dual diagnosis of mental illness and substance use disorder. Methods: This qualitative study involved a review of the research literatures, analysis of policy documents, and interviews with 19 key informants in a case study of the State of Victoria, Australia. Results: The analysis resulted in two broad themes surrounding the implications of dual diagnosis discourse for the mental health sector. The first involves progress regarding the concept of No Wrong Door with subthemes including interprofessional cultural conflicts, intersectoral professional status issues, terminology, problem definition, perspectives on serious mental illness, the role of the client, and pharmacological treatment. The second overarching theme focuses upon informants’ thoughts on future directions for the sector and highlights divided opinion on the implications of dual diagnosis discourse for the mental health service and social care systems. Conclusions: While the perspectives on system change and multiple issues such as resource concerns and cultural clashes are presented here, the informants in this study also gave clear guidance for the future of dual diagnosis work in the mental health sector (e.g., focusing on orienting services toward consumer strengths and recovery), along with recommendations for future research. This paper contributes to the small body of qualitative research on the history and course of efforts to develop appropriate practice in mental health services with regard to patients who have substance use problems and other mental health disorders.

790 – Dual diagnosis of mental illness and substance abuse: an egyptian study

Background The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients. As a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis. Method 683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I (Modules A-E), urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines. Results 22% of the sample fulfill the diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses. Conclusion Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

Australians Living with and Managing Hepatitis C

This paper discusses the psychosocial impact of being diagnosed with hepatitis C virus (HCV). The paper clarifies some of the key misconceptions about the virus, especially the impact HCV has on people who have been recently diagnosed. An individual's reaction to the HCV diagnosis and the subsequent lifestyle challenges to maintain health, well-being, family, and social networks are discussed, particularly the issues surrounding mental health in respect to a recent chronic illness diagnosis and how to manage the trajectory of the illness in the community and individually. HCV disclosure and its effect on intimacy are also detailed.For people living with both a diagnosed mental illness and HCV, managing the illness can be complicated. Not only are these individuals concerned about their mental illness, its treatment, and the social stigma and discrimination associated with it, they also may be alarmed over their future physical health. The paper is preliminary to research using the psychotherapeutic approach of Cognitive Behavioural Therapy (CBT) in groups of persons with a dual diagnosis of mental illness and HCV.

Night Navigation: A Novel

Back to table of contents Previous article Next article Book ReviewFull AccessNight Navigation: A NovelCurtis Adams M.D.Curtis Adams M.D.Search for more papers by this authorPublished Online:1 Dec 2009https://doi.org/10.1176/ps.2009.60.12.1693aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Night Navigation is a journey into the murky present and a dark past. The reader follows an anxious mother named Del and her 37-year-old son Mark, who has a dual diagnosis of mental illness and substance dependence, through a year-long slice of their chaotic lives. Both characters reflect on their very difficult pasts to determine why their lives are on hold. The reader eavesdrops on their thoughts and discussions as they grapple with the two-headed tyrant of mental illness and substance dependence. Mark's illness is a dark bully: clandestine, stealthy, relentless, unforgiving, and domineering. Both characters attempt to conquer it, but they struggle. If Del micromanages Mark's life just so, can she avoid a repeat of past disasters? Will she maintain her boundaries, or will she retreat, as her boyfriend predicts? Will Mark get clean, and if so, will he stay clean? While watching Del's failed efforts to change the course of Mark's life, the reader is treated to her many anxious cognitions and her unalloyed, wishful thoughts. Some of her struggles will make the reader laugh out loud. At the same time, one can empathize with her as she bypasses the many opportunities for a broader, fuller life. She has a grasp of the "love" element of the tough-love dyad but not the "tough" part.Ginnah Howard has facility with addiction lingo. Using Mark to think and blurt out addiction and recovery catch phrases suggests that she has either done a great deal of homework or has had first-hand experience with addiction and its meandering course. To Howard's credit, Mark's words are not forced, overdone, or grotesque. They are often ironic and at times funny. What is less convincing is her depiction of Mark's manic and psychotic processes.Thankfully, Mark and Del's tale doesn't end with all of its loose ends accounted for. After all, the characters don't live uncluttered lives. Instead, Ginnah Howard gives us an entertaining and worthwhile true-to-life story about complicated people grappling with vexing problems.The reviewer reports no competing interests.Dr. Adams is assistant professor, Department of Psychiatry, University of Maryland, Baltimore. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 12 December, 2009Pages 1693-1694PSYCHIATRIC SERVICES December 2009 Volume 60 Number 12 Metrics PDF download History Published online 1 December 2009 Published in print 1 December 2009

Instructional Control of Self-Control in Adults with Co-Morbid Developmental Disabilities and Mental Illness

The present study examined the use of a progressive delayed concurrent schedule to teach tolerance to reinforcer delays with three adults with a dual-diagnosis of mental illness and mental retardation. Participants were initially given a series of choices between a sooner smaller reinforcer available immediately or a larger delayed reinforcer available after various delays ranging up to 5 min. During one of two alternating training conditions, participants were asked to choose between a sooner smaller reinforcer and a larger reinforcer at progressively increasing delays. During the other training condition, identical choices were available but participants were also provided a rule by the experimenter informing them that it was better to select one of the options over the other. Results showed that during baseline all three participants made frequent impulsive choices and selected the sooner smaller reinforcer most often, even at short delay values. However, following training, all participants’ preferences reversed. Furthermore, the effects were enhanced via the delivery of the rule by the experimenter. A 6 month follow-up consisting of rule removal and rule reversal demonstrated the durability of the training procedures over time. Implications for the enhancement of self-control via rule governed behavior is discussed.

First person accounts of long-term employment activity among people with dual diagnosis.

Evidence suggests that many individuals with dual diagnosis of mental illness and substance use disorder can be successfully employed in competitive jobs, though there remain barriers and facilitators to consistent work activity in this population. The purpose of this study is to elicit and examine first person accounts of work activity over a 16-year period from people with dual diagnosis, who were not selected for employment readiness or vocational interests. 120 people with severe mental illness and co-occurring substance use disorder participated in this study. Their work activity was self-reported at yearly interviews occurring over a 16-year period. Participants naturally fell into one of four categories: those who (i) never or hardly worked; (ii) worked intermittently; (iii) worked fairly consistently; (iv) worked very consistently. A more in-depth interview occurred at 16 years when participants gave first person accounts of their 16-year work history in answer to open-ended questions. These responses were analyzed using traditional methods of qualitative content analysis, comparing responses across the four categories of work patterns. Five overlapping themes given by participants as strong influences on work activity arose from the data. These are (i) illness management, including use of psychiatric medication and controlling substance abuse; (ii) personal evaluation of the impact of employment; (iii) congruence between job preference and actual employment; (iv) personal motivation and job-seeking assistance, and (v) the conditioning nature of working or not working. Longitudinal themes of work activity suggest service improvements consistent with evidence-based supported employment.

Mental illness and substance use: An Australian perspective

This paper presents a review of the literature of service trends and practice recommendations for management of those with the dual diagnosis of mental illness and substance abuse. The method for the review was to search bibliographical data bases and hand held literature published in English between 1990 and 2007. Using the search terms dual diagnosis, and co-morbidity and mental illness, 93 abstracts were selected and reviewed. The authors concluded that a collaborative approach to care with better integration of drug and alcohol services within mental health would benefit clients with a dual diagnosis. Improved education to enhance the assessment and diagnosis of this client group is also considered essential for clinicians in both mental health and alcohol and drugs services.

Ethics Consultation in Dual Diagnosis of Mental Illness and Mental Retardation: Medical Decisionmaking for Community-Dwelling Persons

An evaluation of mental capacity is critical to a clinician's judgment about whether or not persons can make medical treatment decisions on their own behalf, and uncertainty about their ability to meaningfully participate in that process is one of the more common reasons an ethics consult is requested. The care of decisionally incapable patients—particularly those who lack advance care documents and no living relative who can speak for them—presents a quandary to healthcare personnel attempting to plan care in their best interest, especially when options are multiple but none are ideal. These situations can be further complicated if involving a patient with a dual diagnosis of mental retardation and mental illness living in a community group home.I acknowledge the support of Mark G. Kuczewski, Professor of Medical Ethics and Director of the Neiswanger Institute for Bioethics &amp; Health Policy Stritch School of Medicine, Loyola University of Chicago, for his guidance and support in the preparation of this manuscript.

Falling Through the Cracks: Supporting Young People with Dual Diagnosis in Rural and Regional Victoria

Research has indicated that people with a dual diagnosis of mental illness and substance abuse are more difficult to manage than any other group of mentally ill clients. For young people with a dual diagnosis, particularly in rural and regional areas, there are significant barriers to the provision of optimal care. Currently, a lack of communication between mental health, drug and alcohol services and consumers results in the inadequate provision of treatment for young people, with a resultant significant service gap. Dual diagnosis programs that focus on both substance abuse and mental health issues demonstrate greatly improved client outcomes. Developing a peer education program provides one constructive way of involving dual diagnosis consumers in developing more responsive health services. It provides a highly structured and supported way of involving consumers who ordinarily find mental health services bewildering and inaccessible. By drawing on the knowledge and skills of young people with dual diagnosis, and involving them as peer educators, the notion of expertise in lived experience is captured and harnessed to provide the establishment of a consumer-focused service that better meets the needs of this complex, often neglected, client group.

Best Friends of People With Mental Illness and Mental Retardation

Back to table of contents Previous article Next article LettersFull AccessBest Friends of People With Mental Illness and Mental RetardationJames R. Dudley, Ph.D., M.S.W.James R. DudleySearch for more papers by this author, Ph.D., M.S.W.Published Online:1 May 2005https://doi.org/10.1176/appi.ps.56.5.610-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Research that focuses on the friendships of people with a dual diagnosis of mental illness and mental retardation is not evident in the literature. Virtually all of the friendship literature has focused on people with a single diagnosis of either mental illness or mental retardation. The findings of published studies largely suggest that people with a single diagnosis tend to look to primarily staff members and to other clients with similar diagnoses to be their friends (1). Studies also reveal that people outside the service system are sometimes identified as friends, however challenging these relationships may be (2). Issues related to stigma are among the major obstacles to making friends, according to the reports of people with mental retardation (3).In an interview study conducted in 2001, a total of 90 people with a dual diagnosis were asked about their friendships. Responses to questions about the person whom they identified as their "best friend" are reported here. Informed consent was obtained from all participants, and the study was approved by the institutional review board of the University of North Carolina at Charlotte. Participants were asked to name the attribute that they like the most about their best friend, what they do together, and what they wish they could do. Responses were compared among four types of friends—other clients, staff members, relatives, and outside friends.The 90 participants were former class members of a federal lawsuit in North Carolina (4). Although they had formerly lived in institutional settings, almost all lived in the community when the study was conducted. The sample included 51 men (57 percent) and 39 women (43 percent). They ranged in age from 26 to 74 years (mean age, 47±12 years). Forty-five (50 percent) were white, 44 (49 percent) were African American, and one was a Native American. Information on diagnoses was obtained from case records. Seventy-nine (88 percent) had a psychiatric diagnosis, including schizophrenia (32 participants, or 36 percent), affective disorder (32 participants, or 36 percent), and impulse control disorder (15 participants, or 17 percent). All had a diagnosis of mental retardation, either mild or moderate.Participants most often identified either another client or a staff member as their best friend (55 participants, or 61 percent). Best friends with whom they had the most frequent contact were also clients or staff members. Best friends who were known the longest were more likely to be family members or outside friends. The preferred attributes of a best friend seemed most varied for outside friends. A few best friends were spouses, were members of the same church, or shared an activity like sports. However, more than a fourth of the outside friendships were inactive.Participants who identified staff members as their best friends (27 participants, or 30 percent) often indicated that the friendship was mutual, but the staff members who were involved usually did not agree. Also, many who identified staff members as friends expressed no desire for help in finding other friendships. This finding suggests that many staff could focus more on teaching friendship skills and facilitating opportunities to develop other friendships. Several projects across the country have extensive experience in helping people with disabilities build and sustain friendships in the community (5). Agencies that serve people with disabilities could also focus staff training on some of the issues that emerge from this study. Follow-up research might consider such questions as what factors best predict the formation and stability of outside friendships, and how the friendships of people with dual diagnoses are similar and different from those of people with a single diagnosis.AcknowledgmentThis study was supported through a contract with the division of mental health, developmental disabilities, and substance abuse services of the North Carolina Department of Health and Human Services.Dr. Dudley is affiliated with the department of Social Work in the College of Health and Human Services at the University of North Carolina at Charlotte.

Managing the Dually Diagnosed Patient — Current Issues and Clinical Approaches, 2nd edn. By D. O'Connell and E. Beyer, The Haworth Press, New York. £33.00. 352 pgs. ISBN 0 7890 0877 7

This text, first published in 1990 and updated for this recent edition, was one of the original textbooks to discuss the management of patients with a dual diagnosis of mental illness and substance misuse. When first published, the number of books published on the subject would barely fill a small shelf. In the intervening twelve years, the texts on dual diagnoses could fill a library. Is there a need for a second edition? The answer is yes. The authors work at the Caron Foundation, a large inpatient addiction treatment centre …

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness