Psychotherapy with dual diagnosis patients: working with denial.

The author discusses a strategy of working with chronically impaired dual diagnosis patients who are in denial of their substance abuse problems. It is argued that due to a number of unique features among such patients, directly confronting denial and insisting on abstinence will not be effective for many of these patients. Instead, it is suggested that patients' continued substance use should be tolerated although at the same time be made a focus of treatment. Techniques are offered which can be utilized to broach the denial of this challenging patient population. Types of patients not suitable for this approach are also discussed.