Introduction

In the field of drug and alcohol addiction, a renewed interest in clinical diagnosis has emerged. From an epidemiological viewpoint this interest has been stimulated by a convergence of clinical populations. There is increasing evidence that significant proportions of the psychopathology population have a high prevalence of drug and alcohol addiction and, concomitantly, increasing numbers of drug and alcohol addiction clients seem to present relatively high rates of psychopathology. This convergence in psychiatric epidemiology has resulted in the emergence of ‘dual diagnosis’ as a clinical and research problem (Wallace & Zweben, 1989; Hesselbrock et al., 1985; Rounsaville et al., 1982; Khantzian & Trece, 1985; van Limbeek et al., 1986; Bukstein et al., 1989; Jaffe, 1984; McLellan et al., 1980, 1983). In this regard, critical remarks have been addressed toward the simple reliance on specific psychiatric diagnosis and far more attention to the severity of psychiatric problems (Stoffelmayr et al., 1989). These criticisms underline a general need throughout psychiatry – the need to refine existing psychiatric diagnostic conceptualizations with data reflective of subtle temporal and contextual variations that contribute to the severity and intensity of these disorders.

Methodologically, the refinement of diagnostic categories can take place in various ways.

Apart from clinical research the refining of existing diagnostic categories can be accomplished through biobehavioral investigations in laboratory and naturalistic settings. These investigations both complement clinical knowledge and, at times, challenge its validity.