Characteristics of dual diagnosis patients admitted to an urban, public psychiatric hospital: an examination of individual, social, and community domains.

The study provides descriptive data on a large, diverse sample of dually diagnosed patients from an urban psychiatric inpatient setting, utilizing a comprehensive array of clinical, social and community functioning measures. The intent is to provide more useful and reliable information, particularly concerning African-Americans with a dual diagnosis in the public sector. Over a one year period, all persons admitted to a public psychiatric hospital with a DSM-III-R psychiatric diagnosis and a positive screen for substance abuse problems using clinical and structured measures (n = 486) were interviewed on the Addiction Severity Index (ASI) and other measures to assess community and social functioning, alcohol and drug use, psychiatric problems, and service histories. The majority of participants were found to have serious economic and employment problems, undesirable living arrangements, limited or conflictive family or social relationships, and some record of arrest. The ASI problem areas most to least in need of treatment were: psychiatric, alcohol and drug abuse, employment, family/social, legal, and medical. Substances most often currently abused were alcohol, cocaine, and cannabis; there was a high rate of polydrug abuse. Participants had experienced a median of 3.0 previous psychiatric hospitalizations, fewer outpatient substance abuse treatments, and limited community mental health contact. Some subgroup differences based on gender, age, and race were found which have implications for community treatment planning. The study results document the extreme heterogeneity in the dually diagnosed as well as their multiple treatment needs. To better inform treatment planning, future research on dual diagnosis should attempt to establish meaningful subgroups relevant to service needs and should utilize diverse clinical and functioning measures.