On Co-occurring Addictive and Mental Disorders: A Brief History of the Originsof Dual Diagnosis Treatment and Program Development
By: Kathleen Sciacca, M.A.
Executive Director, Sciacca Comprehensive Service Developmentfor Mental Illness, Drug Addiction and Alcoholism, MIDAA, e-mail: firstname.lastname@example.orgURL: http://pobox.com/~dualdiagnosisInvited response to section on co-occurring addictive and mental disorders. Published letter tothe editor. American Journal of Orthopsychiatry (66) 3, July,1996.To the Editor,The opening article of the Journal's special section (Osher & Drake,1996) which traces thehistory of separating mental health and addictive services, is an important contribution to theliterature on dual disorders. Since we are now in the early stages of the evolution of dualdiagnosis services, however, I believe it is important to provide a more complete and detailedaccount of the previous initiatives in this field.In response to the article by Drake, Mueser, Clark and Wallach (1996) which states "Ten yearsago the only treatment options available for people with co-occurring substance abuse and severemental illness were parallel treatments in separate programs" (p.49), the record requirescorrection. Dual diagnosis treatment interventions and "integrated" programs that truly adaptedto the needs of severely mentally ill chemical abusers (MICA) began in 1984 (Gigliotti,1986,Sciacca 1987a,1987b) in a New York State outpatient psychiatric facility. In 1985 theseintegrated treatment programs were implemented across multiple program sites (Sciacca,1987b).Concurrently, treatment and program elements were taught through training seminars in NewYork as well as nationally. Early articles by Gigliotti, 1986 and Sciacca, 1987a, 1987b, outlinedthese processes and documented their starting dates. In September, 1986, the New York State(NYS) Commission on Quality of Care (CQC) released the findings of eighteen months of