The scale for treatment integration of the dually diagnosed (STIDD): an instrument for assessing intervention strategies in the pharmacotherapy of mentally ill substance abusers

Psychopharmacotherapy for addictive and comorbid disorders: current studies

Proper diagnosis of comorbid disorders is crucial in treatment planning for the dually diagnosed. Since psychoactive substance use can obfuscate the diagnosis, special care must be taken to exclude organically based syndromes. Adequate periods of abstinence should first be achieved and subsequently the patient re-examined for residual symptoms compatible with a nonaddictive, nonsubstance-induced psychiatric disorder. The integration of concurrent treatment of both the mental and the addictive disorders appears to be the best approach for treatment of comorbid psychiatric and addictive disorders. An abstinence-based model that typically utilizes a 12-step group therapy is often employed for the addictive illnesses. Other forms of psychosocial therapies such as case managers are being used as well. Presently, physicians' prescribing practices for comorbid addicted patients are based on traditional approaches to use of medications in psychiatric patients, and their attitudes towards addictive disorders may play a significant role in determining the overall success of treatment.

Pharmacotherapeutic management strategies for mentally ill substance abusers

In order to determine psychiatrists' strategies for managing the pharmacotherapy and treatment of mentally ill substance abusers, the authors constructed a series of standardized clinical vignettes, each with five multiple-choice treatment interventions. The vignettes, based on clinical experience, depict difficult dilemmas involving the use of medication in the treatment of a variety of dually diagnosed patients. The authors surveyed a heterogeneous reference group of 112 psychiatrists with these vignettes. The psychometric properties of the resultant Scale for Treatment Integration of the Dually Diagnosed (STIDD) are briefly described. The ten vignettes and the treatment interventions chosen by the reference group are described in detail. The results indicate that most clinicians favor an integrated treatment approach which attempts to address both diagnoses.