The use of pharmacology with the dually diagnosed patient needs to be carefully weighed. In most cases the use of antidepressants and certain antipsychotics might be appropriate. Reducing stress in these patients is key to reducing relapse. Psychotherapy along with antidepressants (when indicated) helps to reduce depressive and/or anxious episodes along with teaching coping strategies and healthier ways to respond to the environment. Why is this so and why is it so difficult to successfully treat the dual dx patient?