Dual Diagnosis: A Clinical Perspective Regarding Symptoms and Treatments

Dear Colleagues,

Dual diagnosis, also known as co-occurring disorders, refers to the simultaneous presence of a mental health disorder and a substance use disorder (SUD) within an individual. This complex clinical presentation involves the interplay between psychiatric symptoms and substance use behaviors, with each condition potentially exacerbating the other. The concept of dual diagnosis acknowledges the bidirectional relationship between mental illness and substance use, where one disorder may contribute to the onset or worsening of the other. Common mental health conditions associated with dual diagnosis include depression, anxiety, bipolar disorder, and schizophrenia, alongside SUDs involving alcohol, opioids, or stimulants.

Diagnosing dual diagnosis poses significant clinical challenges due to the overlapping symptomatology of mental health and substance use disorders. Symptoms such as mood disturbances, cognitive impairments, and social dysfunction may be attributable to either psychiatric conditions or substance use, making differential diagnosis complex. A comprehensive assessment typically involves a multi-disciplinary approach, integrating psychiatric evaluations, substance use screenings, and the use of standardized diagnostic criteria from the DSM-5 or ICD-11.

Despite advances in understanding the interplay between mental health and substance use disorders, significant gaps remain in the treatment of dual diagnosis. One of the primary unmet needs is the availability of integrated treatment approaches that address both disorders simultaneously, while traditional models of care often treat mental health and substance use disorders separately, resulting in fragmented care and suboptimal outcomes.

Moreover, there is a pressing need to improve the training of healthcare professionals in recognizing and managing dual diagnosis. Many clinicians lack the requisite skills to navigate the complexities of co-occurring disorders, leading to a misdiagnosis or inadequate treatment plans. The stigma surrounding substance use and mental health conditions further compounds this issue, contributing to delayed help-seeking and under-treatment.

This Special Issue aims to investigate the clinical aspects of dual diagnosis, the treatments available, and the proposal of interventions for these specific conditions, particularly focusing on pharmacological and clinical–pharmacological issues, such as the possibility of drug interactions with ongoing treatments or substances (polysubstance use), age-related characteristics, types of psychiatric disorders and related treatments, settings, and emerging “New Psychoactive Substances” (NPSs), which might be concomitantly abused.

Dr. Stefania Chiappini
Guest Editor

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• dual diagnosis
• psychiatric disorder
• drug interactions
• new psychoactive substances
• abuse