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Dual diagnosis - an unnecessary nosological category?
David Marjot, Consultant Psychiatrist, Kaleidoscope, Surrey

Abstract
Heavy alcohol and drug use can frequently lead to severe depressive, psychotic and behavioural disorders. This is confirmed by experimental and clinical studies. There is a widely held lay and medical view that an addiction is a symptom of another condition or state. Many patients, relatives and their medical advisors explain to themselves or others that they drink or take drugs because A. they have a problem in their lives B. they must have a problem in their unconscious otherwise why should they behave this way? C. they must be mad or at least have another mental disorder.

There is a belief that treating the underlying mental disorder the addiction will be alleviated. It can even be thought that the addiction cannot be treated if another disorder is present! This can lead to the concept of symptomatic addiction in the mad, bad, glad or sad. (the psychotic, psychopathic, manic or depressive). Using 'Occams razor' that we should not use two diagnoses when one will explain the patients condition then we can see that the majority of patients given as dual diagnosis have no such thing. Their drug and/or drug use will fully explain their behaviour. Dual diagnosis is a redundant category. I would expect and hope to make out a good case for my thesis.

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Biography
Up to 1976 senior Consultant Psychiatrist in the Royal Navy and very involved with the problems presented by alcohol.1977-1993 consultant in charge North West Thames Regional Alcoholism and Drug Dependence Unit. Consultant Psychiatrist to HMP Wormwood Scrubs 1976-1996. Since then Advisor to Charities including Landsdone trust, Kaleidoscope, Medical Council on Alcohol and Sick Doctors and Dentists Trust.