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From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (20 July 2026) | Viewed by 6667

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Dr. Angelo G. I. Maremmani

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Guest Editor

Department of Health Sciences, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
Interests: addiction medicine; bipolar disorder; heroin use disorder; affective disorder; opioid maintenance treatment; ADHD

Special Issue Information

Dear Colleagues,

Dual diagnosis—the co-occurrence of psychiatric and substance use disorders—poses one of the most complex challenges in contemporary clinical practice. Traditionally conceptualized as two coexisting conditions, recent frameworks propose a shift toward the notion of dual disorder, understood as a single clinical entity with shared vulnerability, pathophysiology, and treatment needs.

This Special Issue aims to foster a critical reflection on dual diagnosis, welcoming both traditional approaches and innovative models that integrate psychopathological, neurobiological, and therapeutic dimensions.

We invite submissions from psychiatry, addiction medicine, clinical psychology, neuroscience, and public health. Articles may address epidemiological, diagnostic, neurobiological, clinical, or service-related aspects of dual diagnosis and dual disorders, including theoretical and translational contributions.

Topics of interest include (but are not limited to):

Epidemiology and nosology of dual diagnosis;
Clinical pathways and diagnostic challenges;
Neurobiology and genetics of dual disorders;
Early identification and developmental trajectories;
Substance-specific patterns of comorbidity;
Self-medication theory and its clinical implications;
Pharmacological and psychological treatment approaches;
Integrated and multidisciplinary care models;
Dual diagnosis in vulnerable groups (e.g., adolescents, women, forensic patients).

Dr. Angelo Giovanni Icro Maremmani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

dual diagnosis
dual disorder
psychiatric comorbidity
addiction
integrated care
self-medication
substance use
mental illness
treatment models

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Published Papers (5 papers)

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Research

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16 pages, 498 KB

Open AccessArticle

Trends in Hospital Admissions for Psychoactive Substance Intoxication Among Children, Adolescents, and Young Adults in Slovenia, 2013–2023

by Barbara Lovrecic, Mateja Rok Simon and Mercedes Lovrecic

J. Clin. Med. 2026, 15(6), 2112; https://doi.org/10.3390/jcm15062112 - 10 Mar 2026

Viewed by 838

Abstract

Background/Objectives: Intoxication by psychoactive substances (PASs) in children, adolescents, and young adults is a growing public health concern, with evolving patterns of use and hospital presentation. This study aimed to analyze the trends in hospital admissions for PASs among children and youth aged 10 to 24 years in Slovenia during the 2013–2023 period. Methods: We performed a retrospective observational study on patients discharged after hospitalization due to poisoning by PASs, according to ICD 10 AM. We considered four groups: children (aged 10–14), adolescents (aged 15–19) and young adults (20–21 and 22–24 years old). Annual hospitalization rates were stratified by sex, age group, and PAS category. The joinpoint regression model was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC) response time trend. Results: Of those hospitalized, 52% were male and 65% were adolescents, followed by children (13%). A statistically significant decrease in alcohol-related hospitalizations was observed in the 10–14 and 15–19 age groups for both sexes in the period 2013–2023, while a statistically significant increasing trend was observed for alcohol in 22–24-year-old males during the period 2019–2023, and in multiple drug/other/unspecified PASs in the 15–19 age group in the period 2015–2023. Conclusions: Slovenia has some peculiarities in the abuse of PASs. Sex reversal phenomena are present already among children (especially for alcohol), and there are shifting risks in polydrug use in adolescents and emerging threats, as well as an increase in sedative or hypnotic poisoning in female adolescents since 2017. Full article

(This article belongs to the Special Issue From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding)

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Review

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24 pages, 341 KB

Open AccessReview

WADD-SEPD Consensus on Psychological Treatment of Dual Disorders II: Neurodevelopmental, Anxiety, Post-Traumatic Stress, Somatic Symptom, Eating, and Personality Disorders and Recommendations for Future Research

by Ana Benito, Susana Jiménez-Murcia, Judit Tirado-Muñoz and Ana Adan

J. Clin. Med. 2026, 15(3), 1105; https://doi.org/10.3390/jcm15031105 - 30 Jan 2026

Viewed by 1665

Abstract

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. Evidence supports the effectiveness of psychotherapy in treating DDs. The second part of this consensus synthesizes the available evidence on psychological treatment for specific DDs. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: This consensus review encompassed a compilation of recommendations for the psychological treatment of neurodevelopmental, anxiety, post-traumatic stress, somatic symptom, eating, and personality disorders. Finally, recommendations for the future research agenda on the psychological treatment of DD were included. Conclusions: (1) Psychological treatment, particularly integrated treatment, is effective. (2) In the case of dual autism, interventions for substance use disorders should be adapted to this population’s characteristics. (3) More research is needed on dual social anxiety, panic, generalized anxiety, somatic symptom, and eating disorders, for which Cognitive Behavioral Therapy (CBT) is the most commonly used treatment. (4) For dual attention deficit hyperactivity disorder, multicomponent treatment is recommended (psychoeducation, CBT, and peer or family support). (5) For dual anxiety disorders, CBT is the first-line treatment. (6) For dual post-traumatic stress disorder, CBT (cognitive processing therapy and prolonged exposure therapy), acceptance and commitment therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR) are effective. (7) For dual personality disorders, evidence is scarce. (8) For borderline personality disorder, dialectical behavior therapy, dynamic deconstructive psychotherapy, and dual-focus schema therapy show promise. (9) For antisocial personality disorder, CBT, contingency management, and counseling on impulsive lifestyles may be useful. (10) Much more evidence is needed from studies that overcome the methodological limitations of existing ones. Full article

(This article belongs to the Special Issue From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding)

23 pages, 349 KB

Open AccessReview

WADD-SEPD Consensus on Psychological Treatment of Dual Disorders I: General Recommendations, Most Used Therapies, and Severe Mental Disorders

by Ana Benito, Susana Jiménez-Murcia, Judit Tirado-Muñoz and Ana Adan

J. Clin. Med. 2026, 15(2), 730; https://doi.org/10.3390/jcm15020730 - 16 Jan 2026

Cited by 2 | Viewed by 1638

Abstract

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. There is evidence supporting the effectiveness of psychotherapy in their treatment. However, clinical guidelines, consensus statements, and reviews on the treatment of DDs typically devote considerably less space to psychological therapy than to pharmacological therapy. Therefore, this work aimed to synthesize the available evidence, recommendations, and clinical experience on the psychological treatment of DDs to reach a consensus. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: The first part of this consensus review encompassed a compilation of general recommendations for the psychological treatment of DDs, evidence on the efficacy of the most frequently used therapies, and recommendations for the psychological treatment of severe dual mental disorders. These disorders include schizophrenia and other psychotic disorders, bipolar disorders, depressive disorders, and obsessive compulsive disorders. Conclusions: (1) Psychological treatment is effective; (2) integrated psychological treatment is more effective; (3) motivational interviewing, cognitive behavioral therapy, and relapse prevention are the psychological interventions with the most supporting evidence; (4) the best alternative is multicomponent strategies; (5) the most frequently studied severe mental disorders are schizophrenia and depression; (6) for dual schizophrenia, motivational interviewing and integrated cognitive behavioral therapy combined with other components are recommended; (7) for dual depression, cognitive behavioral therapy with relapse prevention or motivational interviewing is recommended; (8) for dual bipolar disorder, group therapies with psychoeducation or relapse prevention and inclusion of the family, contingency management, and family intervention are recommended; (9) more empirical evidence is needed, especially for obsessive compulsive and schizoaffective disorders; and (10) more randomized clinical trials are needed to improve current methodological limitations. Full article

(This article belongs to the Special Issue From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding)

Other

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14 pages, 604 KB

Open AccessPerspective

Depression in Opioid Use Disorder: A Tripartite Psychopathological Model for Dual Disorders

by Angelo Giovanni Icro Maremmani, Filippo Della Rocca, Silvia Bacciardi, Silvia Cimino, Luca Cerniglia, Alessandro Pallucchini, Manuel Glauco Carbone, Mario Miccoli and Icro Maremmani

J. Clin. Med. 2026, 15(14), 5476; https://doi.org/10.3390/jcm15145476 - 13 Jul 2026

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Abstract

Depressive symptoms are highly prevalent among individuals with substance use disorders, particularly opioid use disorder (OUD), yet their clinical meaning is often difficult to determine. In routine practice, these symptoms are commonly interpreted within a binary framework, either as manifestations of an independent mood disorder or as substance-induced states related to intoxication, withdrawal, or early abstinence. Although clinically useful, this distinction may not fully capture a third configuration in which depressive psychopathology emerges within the chronic addictive process itself. This Perspective proposes a tripartite model of depressive states in OUD informed primarily by clinical and dimensional studies conducted in populations with heroin use disorder. First, substance-induced depression refers to mood symptoms temporally linked to the acute or subacute pharmacological effects of substances and generally expected to improve with stabilization or sustained abstinence. Second, an independent mood disorder may coexist with OUD, with particular attention warranted for bipolar-spectrum presentations characterized by affective instability, cyclothymic or irritable temperaments, mixed features, and mood-related patterns of substance use. Third, addiction-related depression describes a persistent depressive configuration associated with reward dysregulation, hypophoria, motivational depletion, cognitive inefficiency, and the Worthlessness/Being Trapped dimension identified primarily in dimensional studies of heroin use disorder. These configurations should not be regarded as rigid or mutually exclusive categories, but as longitudinal clinical formulations that may predominate at different stages of the addictive trajectory. Distinguishing among them may improve diagnostic clarity and support a hierarchical clinical approach in which stabilization of OUD is generally an initial therapeutic priority, while antidepressant and mood-stabilizing interventions are guided by symptom severity, temporal course, psychopathological organization, and evidence of an independent mood disorder. Full article

(This article belongs to the Special Issue From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding)

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16 pages, 830 KB

Open AccessSystematic Review

Concurrent (Dual) Disorder Management Guidelines: Systematic Review Update

by Syune Hakobyan, Zachary Allan, Stephen Lee-Cheong, Kristina Adorjan, Peter Falkai and Christian G. Schütz

J. Clin. Med. 2026, 15(8), 3123; https://doi.org/10.3390/jcm15083123 - 20 Apr 2026

Viewed by 803

Abstract

Background/Objectives: The initial systematic review of “Concurrent Disorder Management Guidelines. Systematic Review” assessed the quality of the concurrent disorders’ clinical management guidelines in 2020, including the guidelines in the field from 2000 to 2020. Twenty-four guidelines were identified and assessed with AGREE II (Appraisal of Guidelines for Research and Evaluation). As dual disorder needs increased specifically among the younger population, requiring significant healthcare resources, more efficient approaches targeting complex concurrent disorders are essential. Since 2020, multiple new guidelines have been developed in response to new developments in the field of substance use disorder management. This systematic review update aimed to identify and appraise all new available concurrent disorder management guidelines to strategize the management of concurrent disorders, support better outcomes and further research directions. Methods: The review was registered, and protocol is available in the international register—PROSPERO. Literature searches were performed by two independent authors in electronic databases and the gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2020 and 2025. Sources that were not formal clinical guidelines, not addressed to physicians for adult age group, addressed to intellectual/developmental disability, or written in languages other than English were excluded. Results: The initial search resulted in 5003 records. A total of eight new guidelines were identified and assessed with AGREE II, highlighting the consistent gap in the evidence-based management recommendations. Conclusions: The appraised guidelines had similar quality to the 2020 findings, supporting dual or combined treatment; however, all guidelines had multiple domains not developed rigorously and with methodological limitations. Levels of complexity and staging of treatment were not considered in recommendations. Average domain scores were very low, with the lowest being applicability and editorial independence. Development of high-quality, rigorously developed, evidence-based guidelines, addressing staging, resource implications, and patient involvement is recommended as the evidence base remains underdeveloped. Full article

(This article belongs to the Special Issue From Dual Diagnosis to Dual Disorder(s): Bridging Comorbidity and Integrated Clinical Understanding)

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