This issue of Psychiatric Annals is devoted to the diagnosis and treatment of the most common psychiatric condition, namely, substance-related disorders. Despite their high prevalence, substance-related disorders have encountered drastic reductions in funding and public support in recent years. Moreover, substance-related disorders are commonly found among patients with other psychiatric disorders. However, "managed care" has carved out or largely eliminated traditional addiction treatment by its arbitrary cuts in reimbursement for addictive disorders. Political and government institutions have not yet afforded equal status to health issues regarding addictive disorders.
The so-called "dual diagnosis" patient is less fortunate because neither the mental health nor the addiction fields receive reimbursement for the diagnosis and treatment of comorbid psychiatric and addictive disorders. The addicted chronically mentally ill or other patients with comorbid disorders typically do not receive services for combined treatments. Of increasing concern is that the criminal justice system is becoming the new "state hospital" because of the dramatic increase in comorbidity in forensic patient populations. Recognition of the reasons for initiation and prolonged incarceration of patients with addictive and psychiatric disorders will require innovative therapeutic interventions and programs.
Clinical judgment, research findings, political momentum, and economic forces appear to be converging on the "integrated model" for treatment of comorbidity. The integrated model calls for sites and settings where staff and methods reflect combined knowledge and skill for the diagnosis and concurrent treatment of psychiatric and addictive disorders. Of paramount importance is that many studies and clinical experience show us that the diagnosis and treatment of addictive disorders will result in a favorable treatment outcome, as measured in abstinence from alcohol and drugs, as well as cost benefits from reduced use of alcohol and drugs, particularly illicit drugs, in any population. The articles in this issue illustrate clinical experience and research data to sustain movement toward greater advocacy and parity for addictive disorders in all populations.