The psychotherapy of dually diagnosed patients.

A model of psychotherapy with dual diagnosis patients is presented. This therapy is divided into 3 phases: achieving sobriety, maintaining abstinence, and advanced recovery. In each of these phases, dual diagnosis patients require many specialized techniques, which are discussed. After sobriety, psychotherapy is behavioral and supportive. When abstinence is stabilized, then psychodynamic principles can be integrated into an approach that recognizes the role played by potential return to substance abuse. Abstinence is even more critical in dual diagnosis patients than in uncomplicated substance abusers. In advanced recovery, more traditional psychotherapy can be done, particularly in nonpsychotic patients.