Mental Disorders and
Heroin Use Disorder (HUD) often co-occur and constitute correlated risk factors that the authors believe are best considered from a unitary perspective. In this article we review and discuss data collected by the V.P. Dole Research Group in Dual Disorder (V.P. Dole DD-RG) patients according to the following six discussion points: (1) Treatment of
personality disorders during
Methadone Maintenance Treatment (
MMT); (2) Treatment of
Mood Disorders during
MMT; (3) Treatment of
Anxiety Disorders during
MMT; (4) Treatment of
Psychotic Disorders during
MMT; (5) Treatment of violence during
MMT; (6) Treatment of
Alcohol Use Disorder (AUD) during
MMT. In treating
Mood Disorder in HUD patients, we must bear in mind the interactions (potentiation and side effects) between psychopharmacology, used substances and agonist
opioid medications; the use of psychiatric medications as an anti-craving
drug, and the possible use of agonist and
antagonist opioid medications in treating the other
mental disorders. In treating chronic
psychosis in HUD patients, we must consider the potentiation and side effects of
antipsychotic drugs consequent on HUD treatment, worsening addiction hypophoria and inducing a more severe reward deficiency syndrome (RDS) in hypophoric patients. Violence and AUD during
MMT can benefit from adequate dosages of
methadone and co-medication with
Sodium gamma-hydroxybutyrate (GHB). The experience of our V.P. Dole DD-RG suggests the following: (a) DD is the new paradigm in neuroscience in deepening our understanding of mental health; (b) To successfully treat DD patients a double competence is needed; (c) In managing DD patients priority must be given to
Substance Use Disorder (SUD) treatment (stabilizing patients); (d)
Antidepressant use is ancillary to SUD treatment;
antipsychotic use must be restricted to acute phases; mood stabilizers must be preferred; any use of
Benzodiazepines (BDZs) must be avoided.