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The prevalence of patients diagnosed with both a psychiatric and an addiction disorder is considerable. Like many other large urban centers, Montreal harbors many of these socially marginalized individuals. In spite of a wide range of resources for the treatment of each condition taken singly, there has been until recently an alarming dearth of programs aimed at providing integrated treatment models. In recent years, the CHUM has endeavored to implement such a program in order to address the multiple needs of a population often rendered vulnerable in many respects. In this article, the authors address the magnitude of this "dual diagnosis" problem, existing intervention models and the obstacles faced by this population in terms of access to health care ; they describe the steps leading to the establishment of an Addiction Psychiatric Unit at the CHUM and the challenges arising from the creation of a multidisciplinary integrated treatment model in an urban setting.

In this article, the authors discuss the difficulties and opportunities of psychiatric training in an urban setting. Based on the example of Montréal, they ponder the interest and the relevance of this contextual framework for the training of future psychiatrists and other mental health professionals, regardless of the nature and location of their practice after their residency. The authors examine the advantages of this teaching environment and how to overcome its limits.