Treating combined alcohol and drug abuse in community-based programs.

The key issues in effective treatment of combined alcohol and drug abuse are identified as comprehensive diagnosis, effective services, and long-term recovery. Empirical data from community-based alcohol and drug treatment studies are presented, illustrating the extent of combined abuse, the lack of treatment for combined abuse, and the negative effects of combined abuse on treatment outcomes. Reconsideration is given to issues such as the concentration of diagnosis on a primary pattern of abuse, the orientation toward concurrent treatment of combined abuse, the requirement of immediate abstinence vs. gradual reduction of combined abuse patterns, and the role of relapse in recovery from combined abuse.