Grella C E
UCLA Drug Abuse Research Center 90024, USA.
J Psychoactive Drugs. 1997 Jan-Mar;29(1):67-78. doi: 10.1080/02791072.1997.10400171.
Dual diagnosis refers to the co-occurrence of substance abuse and mental illness, which may take many forms. Women who abuse alcohol or drugs are more likely than men to be diagnosed with a psychiatric disorder, particularly depression or personality disorder. The interaction of pregnancy, addiction, and mental illness creates complex needs that often go unrecognized by treatment providers. Clinical issues concern adequate prenatal care, use of medications while pregnant and/or nursing, maternal bonding, and coordinated treatment planning among medical, addiction, and mental health treatment providers. Barriers to service delivery to perinatal substance-abusing women with a mental illness include the difficulty in diagnosing a dual disorder, child care and custody concerns, lack of health insurance or funds to pay for treatment, and the stigma associated with mental illness and addiction. Services currently available for the dually diagnosed are typically fragmented and uncoordinated and provision of those services is often hampered by philosophical differences, categorical funding, competition for scarce resources, inadequate staff training, and lack of a central administrative authority or mandate. Several models have been suggested that coordinate services for the dually diagnosed. Awareness of the service needs of dually-diagnosed perinatal women must be included within these models and integrated at all levels of the treatment system.
双重诊断是指物质滥用与精神疾病同时存在，其可能有多种表现形式。酗酒或吸毒的女性比男性更易被诊断出患有精神疾病，尤其是抑郁症或人格障碍。怀孕、成瘾和精神疾病之间的相互作用产生了复杂的需求，而这些需求往往未被治疗提供者所认识到。临床问题涉及充分的产前护理、孕期和/或哺乳期用药、母婴联结以及医疗、成瘾和心理健康治疗提供者之间的协调治疗计划。为患有精神疾病的围产期物质滥用女性提供服务存在诸多障碍，包括难以诊断双重障碍、儿童照料和监护问题、缺乏医疗保险或支付治疗费用的资金，以及与精神疾病和成瘾相关的污名。目前为双重诊断患者提供的服务通常零散且缺乏协调，这些服务的提供往往受到理念差异、分类资金、对稀缺资源的竞争、工作人员培训不足以及缺乏中央行政机构或授权的阻碍。已经提出了几种为双重诊断患者协调服务的模式。这些模式必须纳入对双重诊断围产期女性服务需求的认识，并在治疗系统的各个层面加以整合。
