Training of residents and medical students in the diagnosis and treatment of dual diagnosis patients

FRANÇAIS :
La prise en charge des patients à double diagnostic requiert un traitement simultané de la toxicomanie et des troubles mentaux. Les données disponibles suggèrent que cela n'est pas fréquent. Dans une enquête auprès de plusieurs services psychiatriques, les chefs d'unité rapportent que les double-diagnostics sont sous-estimés, aucun protocole de traitement combiné n'étant prévu, les familles étant rarement impliquées et peu de rapports sur ce type de traitement étant disponibles. Il est donc nécessaire de trouver des enseignants cliniciens compétents et expérimentés dans ce domaine. La formation de ces professionnels doit inclure coopération, compréhension et respect de chacun. Une formation transversale est requise en chimiothérapie, psychothérapie, abstinence d'alcool et de drogues, programmes à 12 étapes, des sujets spirituels et thérapie de milieu. Quelques exemples de ces formations sont présentés.
ENGLISH :
Treatment of dual diagnosis patients requires simultaneous treatment of the addictive and the mental disorders. Available data suggest that this does not happen often. In a survey of several psychiatric services, the unit chiefs reported that dual diagnoses were underreported, no plans were present for combined treatment, families were infrequently involved, and few referrals were made for combined treatment. There is a need for competent, experienced clinician teachers who have had positive experience with the treatment of dual disorders. The training of addiction and mental health professionals must include cooperation, understanding, and respect for each other. Cross-training is needed in chemotherapy, psychotherapy, abstinence from alcohol and other addictive drugs, 12-Step programs, spiritual issues, and milieu therapy. Negative attitudes and ignorance must be overcome for this training to take place. Faculty fellow training programs have provided a beginning in this direction, but have so far involved few professional schools. Some examples of training with regard to referrals, prescribing, and psychotherapy are given. The importance of supervised clinical experience in treating dual diagnosis patients is emphasized. The provision of this experience provides a challenge to specialists in addiction medicine and addiction psychiatry.