Dual disorder – how (in) consistent terminology affects research, diagnosis, and treatment
Authors:
Lenka Varyšová; Lenka Šťastná
Authors‘ workplace:
Klinika adiktologie 1. LF UK a VFN v Praze
Published in:
Čes. a slov. Psychiat., 121, 2025, No. 5, pp. 230-237.
Category:
Review
doi:
https://doi.org/10.48095/cccsp202519
Overview
The relationship between substance use and mental disorders has been studied for over 40 years, yet its interconnection remains a challenge, particularly in terms of definition and classification. The absence of a unified terminology framework complicates the comparability of research, hinders diagnosis, and may negatively impact the availability and quality of care. This article aims to provide a literature review focused on different approaches to conceptualizing this comorbidity, identify key challenges in its definition, and summarize the current state of knowledge. Methodologically, this is a narrative review analyzing existing conceptualizations and classification frameworks, with an emphasis on expert discussions and problematic aspects of terminology. Various approaches to the definition stem either from focusing on specific groups (e. g., the occurrence of psychosis among cannabis users), identifying specific diagnostic combinations (e. g., epilepsy combined with substance use disorder), or analyzing characteristic psychological and behavioral manifestations such as emotional dysregulation or impulsivity. Another approach is based on the type of facility and specific populations in which the occurrence of dual disorders is observed. Some studies adopt a broad definition that includes any concurrent presence of a psychiatric and substance use disorder, while others focus on the severity of these conditions. Increasing attention is also paid to the degree of functional impairment as an indicator of the severity of the mental illness or addiction. One frequently researched and clinically significant example is the combination of a substance use disorder and severe mental illness (SMI), such as schizophrenia, bipolar disorder, or major depression. This combination represents a high-risk group often requiring intensive and integrated care and is therefore frequently considered a prototypical form of a dual disorder. One important aspect is also the temporal sequence of diagnoses—whether the disorders occur simultaneously or one precedes the other. Ongoing expert discussion also establishes whether personality disorders should be included within the concept of dual disorders. The findings highlight the need for harmonized diagnostic criteria, which could contribute to a more effective diagnosis, treatment, and research.
Keywords:
diagnosis – definition – severity – dual diagnosis – dual disorder – co-occurring disorders – psychiatric comorbidity
Sources
1. Růžková J (ed). Podpora lidí s duální diagnózou. Praha: Metropolitní zdravotnický servis 2023.
2. Chomynová P, Dvořáková Z, Grohmannová K et al. Zpráva o nelegálních drogách v České republice 2024 [Report on Illicit Drugs in the Czech Republic 2024]. Praha: Úřad vlády České republiky 2024.
3. Torrens M, Mestre-Pintó JI, Domingo-Salvany A. Komorbidita adiktologických a duševních poruch v Evropě. Praha: Úřad vlády České republiky, Národní monitorovací středisko pro drogy a závislosti 2017.
4. Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis 1970; 23 (7): 455–468. doi: 10.1016/0021-9681 (70) 90054-8.
5. Osher FC, Kofoed LL. Treatment of patients with psychiatric and psychoactive substance abuse disorders. Hosp Community Psychiatry 1989; 40 (10): 1025–1030. doi: 10.1176/ps.40.10.1025.
6. Center for Substance Abuse Treatment. Definitions and terms relating to co-occurring disorders. COCE Overview Paper 1. Rockville (MD): Substance Abuse and Mental Health Services Administration, Center for Mental Health Services 2007. (DHHS Publication No. SMA 07-4163).
7. Hamilton I. The 10 most important debates surrounding dual diagnosis. Adv Dual Diagn 2014; 7 (3): 118–128. doi: 10.1108/ADD-05-2014-0008.
8. Hryb K, Kirkhart R, Talbert R. A call for standardized definition of dual diagnosis. Psychiatry (Edgmont) 2007; 4 (9): 15–16.
9. Český adiktologický institut (ČAI). Doporučené postupy v adiktologii [online]. n.d. [cit. 13. 6. 2025]. Dostupné z: https: //kdp-adiktologie.cz/
10. European Monitoring Centre for Drugs and Drug Addiction. Comorbidity of substance use and mental health disorders in Europe. Luxembourg: EMCDDA 2016. [online]. Available from: https: //www.emcdda.europa.eu/publications/pods/comorbidity-substance-use-mental-health_en
11. Archibald L, Brunette MF, Wallin DJ et al. Alcohol use disorder and schizophrenia or schizoaffective disorder. Alcohol Res Curr Rev 2019; 40 (1): 51–59. doi: 10.35946/arcr.v40.1.51.
12. Li C, Palka JM, Brown ES. Cognitive impairment in individuals with bipolar disorder with and without comorbid alcohol and/or cocaine use disorders. J Affect Disord 2020; 272 : 355–362. doi: 10.1016/j.jad.2020.03.157.
13. Ortiz-Medina MB, Perea M, Torales J et al. Cannabis consumption and psychosis or schizophrenia development. Int J Soc Psychiatry 2018; 64 (7): 690–704. doi: 10.1177/0020764018783882.
14. Clark AE, Goodwin SR, Marks RM et al. A narrative literature review of the epidemiology, etiology, and treatment of co-occurring panic disorder and opioid use disorder. J Dual Diagn 2021; 17 (4): 313–332. doi: 10.1080/15504263.2021.1912112.
15. Barry DT, Beitel M, Cutter CJ et al. Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder. Drug Alcohol Depend 2021; 221 : 108608. doi: 10.1016/j.drugalcdep.2021.108608.
16. Yuan Y, Padgett D, Thorning H et al. “It’s stable but not stable”: a conceptual framework of subjective housing stability definition among individuals with co-occurring mental health and substance use disorders. J Dual Diagn 2023; 19 (2–3): 111–123. doi: 10.1080/15504263.2022.2156234.
17. Maremmani AGI, Pani PP, Rovai L et al. Toward the identification of a specific psychopathology of substance use disorders. Front Psychiatry 2017; 8 : 1–10. doi: 10.3389/fpsyt.2017.00126.
18. Toledo-Lozano CG, Arganis-Juárez EN, Tiburcio-Sainz MA et al. Illness perception and explanatory models involved in health services for addictive disorders and dual disorders in Mexico. Int J Ment Health Addict 2023; 21 (3): 1854–1866. doi: 10.1007/s11469-022-00870-0.
19. Grant BF, Saha TD, Ruan WJ et al. Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiatry 2016; 73 (1): 39–45. doi: 10.1001/jamapsychiatry.2015.2132.
20. Carrà G, Bartoli F, Clerici M, El-Guebaly N. Psychopathology of dual diagnosis: new trumpets and old uncertainties. J Psychopathol 2015; 21 (4): 390–399.
21. Buckley PF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry 2006; 67 (Suppl 7): 5–9.
22. Zimmerman M, Morgan TA, Stanton K. The severity of psychiatric disorders. World Psychiatry 2018; 17 (3): 258–275. doi: 10.1002/wps.20569.
23. Ministerstvo zdravotnictví ČR. Doporučené postupy pro vznik nových CDZ. Praha: Ministerstvo zdravotnictví ČR 2021. [online]. Dostupné z: https: //www.reformapsychiatrie.cz/download/doporucene_postupy_CZ.pdf
24. Iudici A, Girolimetto R, Volponi G et al. Dual diagnosis and application problems in the use of the construct: a review of literature. J Nerv Ment Dis 2020; 208 (3): 181–189. doi: 10.1097/NMD.0000000000001127.
25. Cullen OJ, Norton MJ. Chicken or egg: a dual diagnosis narrative. J Psychiatr Ment Health Nurs 2022; 29 (4): 507–511. doi: 10.1111/jpm.12788.
26. Todd J, Green G, Harrison M et al. Defining dual diagnosis of mental illness and substance misuse: some methodological issues. J Psychiatr Ment Health Nurs 2004; 11 (1): 48–54. doi: 10.1046/j.1365-2850.2003.00691.x.
27. World Health Organization. International classification of diseases for mortality and morbidity statistics (11th revision). Geneva: WHO 2019. [online]. Available from: https: //icd.who.int.
28. Samaha AN. Can antipsychotic treatment contribute to drug addiction in schizophrenia? Prog Neuropsychopharmacol Biol Psychiatry 2014; 52 : 9–16. doi: 10.1016/j.pnpbp.2013.10.010.
29. Department of Health. Mental health policy implementation guide. Dual diagnosis good practice guide. London: Department of Health Publications 2002.
30. Riegel KD, Kalina K, Pěč O. Poruchy osobnosti v 21. století: diagnostika v teorii a praxi. Praha: Portál 2020.
31. Šťastná L. Analýza duálních poruch u pacientů Adiktologické ambulance Kliniky adiktologie. Diplomová práce. Praha: Univerzita Karlova 2025.
Labels
Addictology Paediatric psychiatry PsychiatryArticle was published in
Czech and Slovak Psychiatry
2025 Issue 5
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