Mental health and chemical dependency clinicians have differing beliefs in regard to the etiology, diagnosis, and treatment of dually diagnosed patients. The differing views of the relationship between psychopathology and chemical dependence often result in fragmented and inadequate care, with the patient being shunted back and forth between mental health and chemical dependence treatment facilities. This article includes a discussion of the impediments to effective and comprehensive treatment for dually diagnosed patients as well as a case history to illustrate commonly encountered difficulties. A model treatment approach for dually diagnosed patients is described to provide clinical guidelines for effective programing. In addition, a number of recommendations identify needed changes in the mental health and chemical dependency fields at the clinical and administrative levels.

Craving and relapse are complex, poorly understood phenomena. A distinctive and baffling characteristic of the disease of chemical dependency is the continuing impulse to use alcohol and/or other drugs, even after lengthy periods of sobriety. This article discusses relapse prevention, focusing on public-sector chemically dependent women. Relapse among these women must be seen in the total context of their lives. Poverty and social disorganization do not directly cause relapse, but problems related to daily life under such conditions represent significant risk factors. The Eagleville Hospital treatment model and relapse prevention programs are described, and it is noted that public-sector women typically present with problems related to being raised in addicted households, residing in drug-saturated inner-city environments, deficits in child-rearing skills, destructive (often abusive) relationships with men, social interactions involving other substance abusers, few (if any) work skills, minimal educational achievement, low self-esteem, and poor self-image. A case study illustrates the course of treatment and relapse prevention efforts with a typical public-sector chemically dependent woman.

The philosophy, history, and operations of the Vocational Opportunities Center (VOC) are described. The functions of VOC include intake and evaluation, vocational and educational training, job development, child care, a women's vocational group, legal services, and cultural activities. The VOC is offered as a model of employability service to a specific client group and part of a more comprehensive multimodality drug program.

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