Il paziente alcolista con comorbidità psichiatrica : dalla diagnosi alla presa in carico presso un Day Hospital riabilitativo

Rehabilitative programmes for patients with Dual Diagnosis : a Day Hospital experience The common integrated approach to alcoholdependence combines different medical and psychosocial treatments, in individual, group or familiar settings, to achieve and support alcohol abstinence and improve global psychosocial functioning. These clinical goals are more difficult to achieve in psychiatric patients than in the alcoholics without psychiatric diseases; psychiatric patients show low global functional level, few familiar and social supports, cognitive and psychological disabilities, so they need measured and more supportive personal programmes for a long time. In this paper we report our experience of rehabilitative treatments for patients with alcoholdependence and psychiatric comorbidity. We analyse the clinical results (abstinence and clinical outcome) of the rehabilitative programmes set out in the rehabilitative Day Hospital of Psychiatric Dept. of University of Milan for patients with alcoholdependence and psychiatric comorbidity. We report and discuss 2 years outcome of 20 alcoholics with psychiatric comorbidity treated in day hospital and 21 alcoholics without comorbidity, undergoing out-patients treatment. Preliminary data analysis confirm international literature results: the 42% of day hospital sample and 58% of outpatient sample achieves and maintains the alcohol abstinence during the two years of follow up; the compliance and outcome seems to be better in alcoholics with axis I Diagnosis (affective disorder) than axis II (Personality Disorders); data confirm that two or more dual diagnosis are associated with worse compliance and outcome.