Patients who have both a psychiatric disorder and a substance abuse problem cause most clinicians to throw up their hands in despair. The clinical problems that these "dual diagnosis" patients present are enor- mously complex. Diagnostically, how is one to tell if disorders of mood and thinking, for instance, are signs of a mental illness or consequences of substance abuse? How is one to obtain important historic information when the patient may be unable or unwilling to provide it and there are no readily available collateral sources of information? In any case, why bother? Treatments for...

Sodetal attitudes toward alcoholism are characterized by several types of denial, with disastrous personal and sodal consequences. Refusal to admit the extent of alcoholism as a major national health problem leads to a public policy which allocates relatively few resources to research, prevention, treatment, or rehabilitation. On an individual basis, the combination of sodally approved drinking and the stigma assigned to the chronic alcoholic results in individuals blinding themselves to the existence of the problem in family, friend, and self until it has reached such an advanced or obvious...