THE CHALLENGES OF DUAL DISORDERS

Abstract

Introduction. The dual disorder in patients with addiction is common. Still, it is necessary to treat both the addiction and the mental disorder because when only one illness is treated, the results are not achieved, or at least they are not as good as when both conditions are treated. But, to treat diseases, they need to be diag- nosed first. This paper aims to present cases from clinical practice where preliminary diagnosis and “scoto- ma” - non-recognition of addiction led to poor treatment and outcome. Methods. Five points from clinical practice that were referred to or treated at the Centers for Prevention and Treatment of drug use (CPTD) are analysed. Results First case is about “masked heroinism” treated with benzodiazepines, neuroleptics and antidepressants as alcoholism and anxiety and depressive disorder with a history of suspiciousness, that was referred to the CPTD due to: “Relapses present. Re-evaluation of comorbidity is necessary”. The second World Association on Dual Disorders VII World Congress Portoroz, Slovenia April 28-30, 2023 13 case is Roma, with opiate addiction and cannabis use. Due to psychosis, he was treated in a psychiatric hos- pital with oral and depot Haloperidol and 2-3 ml of methadone and was referred to continue the treatment in CPTD. In this case, discontinuing neuroleptic therapy and increasing the dose of methadone provided stabilisation without relapses of psychosis.The third case is a patient who was treated for schizophrenia and who, 20 years after the start of drug use at the age of thirteen and 15 years after the first hospitalisation in a psychiatric hospital, was diagnosed by a general practitioner as addicted and was involved in OAT. It was probably cyclothymia in childhood and the use of cannabis that caused hallucinations and, later, opiates. The patient is currently on buprenorphine, is abstinent from all drugs and is not psychotic (“the schizophre- nia” disappeared), but in the meantime, he had a lot of suffering, hospitalisations, overdose, etc. The fourth case is a dual disorder of schizophrenia and opiate addiction, which was treated 25 times in a psychiatric hospital without treatment of opiate addiction, which resulted in a significant burden for the patient, family and society, frequent relapses, violence, police assistance, ambulance assistance, etc. The fifth case is a pa- tient underdosed with OAT, leading to continued alcohol use. The psychiatrist had no insight that the patient was using alcohol, although he knew that before using opiates, he had used alcohol and cocaine. During surgical intervention, the patient abstained from alcohol for several days and developed delirium tremens alcoholism. Conclusions. Lack of knowledge about substance use disorders among psychiatrists leads to inadequate diagnosis and thus treatment of patients with dual disorder. Treatment of dual disorder requires the physician’s competency and comprehensive treatment of both the substance use disorder and the mental disorder. Educating psychiatrists about substance use distances is imperative because their “scotoma” on substance use disorders seriously burdens individuals, families, and the community.