COMPLEMENTARY HYPOTHESIS

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Since we started working with Dual Diagnosis patients in residential centres and, based on our experience, we have observed certain elements which appear with regularity. Given, on the one hand, the sample with which we work, which is unavoidably slanted (people with Dual Diagnosis receiving outpatient treatment and able to be admitted to a residential centre) and, on the other hand, our structural limitations due to the fact we are an association, we have chosen to present as a hypothesis certain facts that appear repeatedly and have been observed by our professionals, in order to guide or give way to future research.

 

 

Clinical-factorial interaction hypothesis

Clinical Predominance Hypothesis

Significant Symptomatology Hypothesis

 

 

 

 

Clinical-factorial interaction hypothesis


• We believe that the interaction between drug dependency and a mental disorder is factorial (i.e, mutually determining).


• Moreover, other circumstances can be included that interact in a factorial way (determinant) or added (conditioning).


• The factorial interaction affects the clinical picture as a whole (for instance, the occurrence of a determinant third variable such as a mental handicap which compromises the treatment efficiency and the consolidation of therapeutical achievements leading to the discharge).


• The added interaction influences by affecting certain areas but not having a direct effect on the clinical nucleus (an example of this would be self-esteem in HIV patients, which does not compromise the psychopathological stability or abstinence maintenance directly or at origin).


• The effect of a mental handicap or AIDS-Dementia complex, for instance, would be factorial.


• A stable and chronic HIV or a clinically controlled HCV among others will have an added influence.

 

 

 

 

Clinical Predominance Hypothesis


• Dual diagnosis as a result, is qualitatively different to the axes that form it.


• Even though our assistance does not focus on it, one of the axis is primary and caused the second one, creating the dual diagnosis picture.


• Because of this, we could theoretically estimate and check the existence of a preponderant axis (more vulnerable and slightly weaker).


• As a result, and depending on the patient, the vulnerability will be higher in one of the two axes.


• Our focus should be on the more vulnerable one, without forgetting the other, in order to ensure the prevention of general relapses.

 

 

 

Significant Symptomatology Hypothesis


In our experience, we can pinpoint (with reservations) the predominant pathological axis by observing the negative symptoms.

 

Thus, we have:


• A predominant psychopathological axis: Where the negative symptoms are significant and seriously compromise the patient’s  level of autonomy and interpersonal competence. That is, there is a clear defectual deterioration.

 

• Addiction predominant axis: The effect of the negative symptoms with regards to autonomy and interpersonal competence is notably lower.
That is, there is a good conservation level, especially with regards to social skills.



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