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Rethinking Dual Disorders/Pathology

Szerman, Nestor MD; Martinez-Raga, Jose MD, PhD; Peris, Lola MD; Roncero, Carlos MD, PhD; Basurte, Ignacio MD; Vega, Pablo MD; Ruiz, Pedro MD; Casas, Miguel MD, PhD

Addictive Disorders & Their Treatment: March 2013 - Volume 12 - Issue 1 - p 1–10
doi: 10.1097/ADT.0b013e31826e7b6a
Original Articles

Objective: Comorbidity of addictive disorders and other psychiatric disorders is very common. The optimal treatment of patients with addiction disorders requires awareness of their comorbid mental disorders and vice versa. The operational and contextual definitions of the different terms used vary significantly. To address this terminology problem the present document proposes and, therefore, has chosen the term ‘dual pathology.’

Methods: The present paper aims to discuss the most current evidence regarding the multiple genetic, developmental, and environmental factors underlying the complex interactions that modulate the vulnerability and trajectories of patients with dual pathology. It, thus, goes beyond the current prevailing view of considering patients as having primarily either an addictive disorder or any other mental disorder and may have an additional comorbid psychiatric disorder.

Results: It is time to rethink mental disorders, including addictive disorders and dual disorders or dual pathology, recognizing that these are disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience, and may therefore be considered neurodevelopmental disorders. The view of dual pathology as a neurobiological systems failure should help us to develop more comprehensive interventions for optimizing the ways in which we prevent and treat a complex, multifactorial, likely neurodevelopmental disorder such as dual pathology.

Conclusions: Despite the scientific evidence, there are beliefs and, as a result, certain resistance or barriers that have hindered the recognition and acceptance of dual pathology in daily clinical practice or in research. Twelve of these common barriers are addressed and discussed.

*Sociedad Española de Patología Dual (Spanish Society of Dual Pathology), Madrid

Hospital General Universitario Gregorio Marañón

**Instituto de Adicciones, Madrid-Salud, Madrid, Spain

Psychiatry Department, Hospital Universitario Doctor Peset

§Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain

Department of Psychiatry, Hospital Universitari Vall d'Hebron

#Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

Centre Neuchâtelois de Psychiatrie-CNP, Neuchâtel, Switzerland

††Department of Psychiatry and Behavioural Sciences, Miller School of Medicine, University of Miami, Miami, FL.

The authors declare no conflict of interest.

Reprints: Nestor Szerman, MD, Sociedad Española Patología Dual (SEPD), Jefe Servicio Salud Mental Retiro, Hospital General Universitario Gregorio Marañón, CSM Retiro, Calle Lope de Rueda 43, Madrid 28009, Spain (e-mail:

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