After 20 years of development and research, dual diagnosis services
for clients with severe mental illness are emerging as an evidencebased
practice. Effective dual diagnosis programs combine mental
health and substance abuse interventions that are tailored for the
complex needs of clients with comorbid disorders. The authors describe
the critical components of effective programs, which include a
comprehensive, long-term, staged approach to recovery; assertive outreach;
motivational interventions; provision of help to clients in acquiring
skills and supports to manage both illnesses and to pursue
functional goals; and cultural sensitivity and competence. Many state
mental health systems are implementing dual diagnosis services, but
high-quality services are rare. The authors provide an overview of the
numerous barriers to implementation and describe implementation
strategies to overcome the barriers. Current approaches to implementing
dual diagnosis programs involve organizational and financing
changes at the policy level, clarity of program mission with structural
changes to support dual diagnosis services, training and supervision
for clinicians, and dissemination of accurate information to consumers
and families to support understanding, demand, and advocacy. (Psychiatric
Services 52:469–476, 2001)