Implementing appropriate treatment of patients with dual diagnosis is one of the most vexing conundrums in contemporary psychiatry. Surprisingly, however, there have been few reports of the use of case management in treating this patient group, despite its apparent face‐value applicability to this difficult clinical population. The authors report their experience in applying case management to a group of “depressed” and/or “negative‐symptom” schizophrenic patients with substance abuse problems. They found most problematic areas were confidentiality, treatment compliance, and the necessity and timing of abstinence. Discussion of these issues is illustrated with c