{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:17:35Z","timestamp":1761218255896,"version":"build-2065373602"},"reference-count":75,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T00:00:00Z","timestamp":1593734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>When psychiatric illness and substance use disorder coexist, the clinical approach to the patient is, unsurprisingly, awkward. This fact is due to a cultural context and, more directly, to the patient\u2019s psychiatric condition and addiction behaviors\u2014a situation that does not favor a scientific approach. In dual disorder facilities, several types of professionals work together: counselors, social workers, psychologists, and psychiatrists. Treatment approaches vary from one service to another and even within the same service. It is crucial to provide dual disorder patients with multiple treatments, comprising hospitalization, rehabilitative and residential programs, case management, and counselling. Still, when treating dual disorder (DD) heroin use disorder (HUD) patients, it is advisable to follow a hierarchical algorithm. First, we must deal with addiction: by detoxification, whenever possible. This means starting most patients on anti-craving pharmacological maintenance, though aversion therapy may be appropriate for a few of them. Opiate antagonists may be used with heroin-addicted patients as long as those patients are only mildly ill. In contrast, agonist opioid medications, i.e., buprenorphine and methadone suit moderately and severely ill patients, respectively. Achieving control of mood instability or psychotic episodes is the next step, to be followed by a prevention strategy to counteract residual cravings and dominate mood disorders or psychotic episodes through long-term pharmacological maintenance that is focused on a double target.<\/jats:p>","DOI":"10.3390\/jcm9072098","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T09:49:11Z","timestamp":1594028951000},"page":"2098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Conceptual Framework of Dual Disorders and Its Flaws"],"prefix":"10.3390","volume":"9","author":[{"given":"Matteo","family":"Pacini","sequence":"first","affiliation":[{"name":"G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo G. I.","family":"Maremmani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, 55049 Viareggio, Italy"},{"name":"PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy"},{"name":"Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Icro","family":"Maremmani","sequence":"additional","affiliation":[{"name":"G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy"},{"name":"Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy"},{"name":"Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,3]]},"reference":[{"key":"ref_1","unstructured":"Ries, R.K. (1994). Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse. Treatment Improvement Protocol (TIP) Series 9, Center for Substance Abuse Treatment."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4088\/JCP.0706e01","article-title":"Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness","volume":"67","author":"Buckley","year":"2006","journal-title":"J. Clin. 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