BOOK REVIEW
Integrated Treatment for Dual Diagnosis—A Guide to Effective Practice. By Kim T. Mueser, Douglas L. Noordsy, Robert E. Drake and Lindy Fox. Guilford Press, 2003. £31.95. 526pgs. ISBN 1 57230 850 8.
If you have been looking for a book, which explains, in a comprehensive fashion how to deliver integrated treatments in Dual Diagnosis, this is the book. It is based on a wealth of clinical experience from some of the foremost researchers from USA and is excellently and coherently written. The book is predominantly for clinicians who wish to develop services for individuals with serious mental illness and substance misuse problems but almost exclusively looks at the development of integrated programmes of care. This is potentially at variance with the picture in the UK where the emphasis has been on mainstreaming dual diagnosis and enhanced capacity of general mental health services in dealing with drug and alcohol problems and drug and alcohol services dealing with a range of mental health problems presenting in their patients. However, despite this potential variance there is much to recommend in this book.The initial chapters relate to the background information in terms of prevalence of dual diagnosis, comparison of integrated treatment models with other models of delivering care to individuals with dual diagnosis and how the authors have organized dual diagnosis services over the past 20 years. There is also a review of the assessment of individuals with serious mental illness and dual diagnosis both from the perspective of detecting substance misuse and reviewing the behavioural effect of that substance misuse and the motivation to change.
The authors described a variety of treatment approaches which can be used with this population, including a clear description of a stepwise case management based on the individual's stage of change, the role of motivational interviewing and cognitive behavioural therapy for individuals with disorders that have a dual diagnosis. There was also a discussion of group interventions, including the utilization of self-help groups such as AA and the use of behavioural family therapy. It is interesting that the shortest chapter in the book is on the evidence base for integrated dual disorder treatment and this is particularly so in terms of the use of this model outside of the USA.
There are a series of very useful Appendices, including educational handouts for patients and therapists and a series of assessment instruments that examine the assessment of drug and alcohol use, functional analysis of mental health problems, stage of change and assessment of the family. These can all be used in everyday practice. Even if the general model adopted in the UK is different from that in the USA, there is much in this book that can be utilized by clinicians. There remains an urgent need to review the current models being developed in the UK.
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