Alcohol and Alcoholism Vol. 38, No. 1, pp. 95, 2003
© 2003 Medical Council on Alcohol
BOOK REVIEW
Dual Diagnosis.
Edited by G. Hussein Rassool. Blackwell Science, Oxford. 2002, 230pp., £22.50. ISBN 0-632-05621-5.
As a British general psychiatrist, albeit one with an interest in addictions, dual diagnosis was a term that crept up on me and entered common parlance without a full understanding of its history, or value. This useful text produced by a team of experts largely from St George’s Hospital (London) rectifies some of these gaps in my knowledge. The authors are from a variety of professional backgrounds providing a stimulating mixture of views on dual diagnosis, though at times it can be repetitive, somewhat a problem of multi authored texts.
The book is structured into two parts. The first section provides an overview of dual diagnosis, including its origins, with much debate on its construct validity and utility. The second part gives a more practical account of various service and professional responses to developing appropriate therapies.
The book opens with some debate over definitions and it soon becomes apparent through subsequent chapters that ‘dual diagnosis’ may already be out of date. Fred Roach in a dense chapter describes some interesting preliminary research on ‘complex behaviour’. The latter referring to behaviour which contains a ‘main characteristic (e.g. psychiatric illness or personality disorder) and one or more subordinate characteristics with one or more intra- or inter-related features (e.g. aggression, violence, etc)’. He highlights the dangers of a dual diagnosis concept in treating linked conditions and behaviours as being due to separate disorders, once more raising the issue of the applicability of the much-maligned medical model for psychological medicine. This difficulty is picked up in the following chapter by Flanagan, who emphasizes the problems of inter-agency collaboration and the all too familiar scenario of patients being shunted from one team to another when they do not fit the service specification.
I found the utility of Part 2 more variable. Rawaf provides a public health perspective even though early in his chapter he acknowledges ‘there is currently no agreement among various mental health professionals about what constitutes dual diagnosis, who should lead in assessing and treating these patients and how services should be delivered’. Despite this, Lowe, in the following chapter describes the development of a dual diagnosis service in Harringey. This includes some very useful information and tips for anyone contemplating a similar campaign. With a mouth-watering range of resources the Harringey team provides focused short-term interventions before passing patients onto longer-term agencies. It was not clear how this type of service development was expected to relate with the emerging Assertive Outreach Team (AOT), as envisaged within the National Service Framework for Mental Health. The AOTs are expected to have experience and skills in managing patients with substance misuse problems.
To conclude, I would recommend this as a useful postgraduate text on the subject and some stimulating reading for the general psychiatrist. The latter may well be cynical with regard to the concept of dual diagnosis, considering it as epiphenomena of the fragmentation of good generic psychiatric services and the internecine disputes that inevitably follow.
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