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Heroin Addiction and Related Clinical Problems: 2011, 13, 1 (pages: 29 - 34)

Dual Diagnosis (Comorbidity): A growing diagnostic and treatment issue in the psychiatric and substance use programmes in the Republic of Macedonia

Tulevski I. G.

Summary: The purpose of this paper is to describe several existing problems encountered in the management of dual diagnosis (DD) in the psychiatric and drug treatment institutions in Macedonia. The term DD or comorbidity refers to the co-occurrence of at least one mental and behavioural disorder due to psychoactive substance use with another psychiatric disorder in the same individual. These ‘dual' subjects present greater severity from both the clinical and social perspectives than those who have only one type of psychiatric disorder. The cost to the health system for those with DD is significantly higher than it is for someone with a single psychiatric disorder. This presents a significant challenge with respect to the identification, prevention and management of people with DD. According to the 2004 Report by the EMCDDA, the prevalence of DD in treatment settings in various EU countries ranged between 22% and 96%. In the Day Hospital for the Prevention and Treatment of Drug Dependencies in Kisela Voda, Skopje in an 8-year period, 1995-2002, 9.8% – 49 out of a group of 500 heroin users – were diagnosed as ‘dual' patients. The unmet need for treatment of people with DD is considerable. People with DD often found themselves in the gap between the relevant services, namely between the Day Hospital in Kisela Voda, and the Psychiatric Hospital in Skopje, or, less frequently, in prison. In Macedonia guidance regarding the best practice for the treatment of individuals with DD is not available. Access to services for people with DD diagnosis is restricted. They are under-diagnosed and receive very little treatment. The present Author has stressed the need for increasing the capacity of the health care system in Macedonia to meet the needs of people with DD. Further research is needed to establish the prevalence of DD, and to improve the diagnosis, treatment and social rehabilitation of people with DD.