THERAPEUTICS AND TOXICOLOGY: Edited by Robert O. WrightPsychiatric disease and drug abuseSantucci, Karen Author Information Yale University School of Medicine, New Haven, Connecticut, USA Correspondence to Karen Santucci, MD, Section Chief and Medical Director, Pediatric Emergency Medicine, University Towers, 100 York Street, Suite 1 F, New Haven, CT 06511, USA. Tel: +1 203 737 7435; fax: +1 203 737 7447; e-mail: [email protected] Current Opinion in Pediatrics: April 2012 - Volume 24 - Issue 2 - p 233-237 doi: 10.1097/MOP.0b013e3283504fbf Buy Metrics Abstract Purpose of review The term ‘dual diagnosis’ most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7–10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this ‘dual diagnosis’, particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention. Recent findings Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use (‘self-medication hypothesis’) and bidirectional (presence of either mental illness or SUD can contribute to the development of the other). Summary Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis. © 2012 Lippincott Williams & Wilkins, Inc.