ABSTRACT
Without physician leadership, and the clinical and scientific expertise the profession of addiction psychiatry entails with respect to knowing both mental illness and addiction diseases, integrated dual diagnosis care and the 2 × 4 Model system itself cannot really work. Although workforce deficiencies in nurses and therapists who are cross trained in addiction and mental health are also an issue in behavioral health, the remedy for this is somewhat less complicated than for addiction psychiatrists, because the formal training of these professionals does not require medical school, psychiatric residency, and fellowship. Smart phones and wristwatch/wearable monitoring technologies are now available that can monitor, in real-time or in multi-day summaries, a number of biological and behavioral variables including heart rate, wake/sleep time, motor activity, and location. Exposure to early abuse, neglect, trauma, and attachment disruption are contributory to dual diagnosis disorders in adulthood.
