The dual-diagnosis patient in a psychiatric day treatment program: a treatment failure.

This study was undertaken to determine the effectiveness of treating the dual-diagnosis patient in a standard psychiatric day treatment program. These patients, presenting with psychiatric disorder coexisting with alcohol and/or drug abuse, present a major problem in treatment because of their emotional fragility, their propensity to impulsive acting-out behaviors, and their adaptation to psychiatric symptomatology via self-medication with illicit drugs. Of the 24 dual-diagnosis patients admitted to our Day Treatment Center in 1988, 57% left treatment at or before 8 weeks following admission, as opposed to 21% of a nonsubstance abusing psychiatric control group. Their rate of absenteeism and suspensions for continuing abuse and infraction of the rules was four times that of the controls. In light of these data, it appears that these patients require highly specialized treatment strategies not generally available in a conventional psychiatric day hospital.