Evaluation and acute management of psychotic symptomatology in alcohol and drug addictions.

The practical clinical evaluation of patients manifesting psychotic symptomatology and addictive illness is approached in diverse and contradictory ways. While addiction specialists may not recognize the existence of Axis I disorders that prevent the utilization of treatment in the system, trained mental health professionals are traditionally prone to deny or minimize the addictive process and its capacity to produce psychiatric symptoms. This may result in premature diagnosis, and in a poor response to psychiatric treatment. The purpose of this paper is to describe a pragmatic model, based on clinically observable conditions, for the evaluation and acute management of major psychiatric symptomatology associated with diagnosed drug and alcohol addiction. Before describing the model, psychotic illness and symptoms in the general population versus the drug and alcohol addicted will be examined. The model will be applied to a few discrete syndromes based on common clinical presentations.