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...

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...

It is well known that alcoholism continues to be one of this country's major public health problems. This issue is carefully documented by Dr. Gerald Klerman, Chief of ADAMHA, in the second chapter ofthis volume. In spite of the major role that alcohol plays in the health care issues of internal medicine, neurology, and psychiatry, the subject continues to fall between the cracks of the various disciplines. For this reason, it has become almost a discipline of its own; yet there are no academic departments of alcoholism because academic departments are unidisciplinary and alcoholism is...