Vistas Online 2005

VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.


A New Approach to the Dual Diagnosis Controversy: Counseling’s Version of The Emperor’s New Clothes

Ron Shaver


The dual diagnosis designation appears to be a new or recent trend in diagnosis and treatment and has created a number of problems beyond just the availability of spaces in inpatient programs. “The psychiatric and substance abuse treatment systems have been, historically, very separate and very different in philosophy, methods, and staff backgrounds, and bringing them together is a complex and challenging task …” (Ryglewicz & Pepper, 1996, p. 78). Many mental health programs are hesitant to accept individuals with cooccurring addictive disorders due to what is perceived as treatment resistance. Also, addiction treatment programs, many of which rely on the therapeutic community treatment model, are hesitant to accept individuals also diagnosed with non-drugrelated problems, especially those that are often treated with psychiatric medications. Research has suggested that “severely mentally ill clients worsened over time when treated in the therapeutic community programs. This negative outcome is thought to be related to some of the characteristics of the therapeutic community model: sanctions against the use of psychotropic medications, the use of paraprofessionals and ex-addicts as counselors, and punitive or embarrassing confrontational group encounters” (Watkins, Lewellen, & Barrett, 2001, p. 20). Thus, this dual diagnosis assessment and treatment issue poses a number of questions.

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