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Introduction by the column editor: This column, by Dr. Anderson from the College of Public Health at the University of Iowa, deals with the conundrum of dual diagnosis among adolescents. The problems Dr. Anderson describes are all the more daunting because of the real-life issues of finding services in a rural setting. Her paper, which represents an overview of mental health, substance abuse, and public health, fits well with the column's theme of collaboration and building systems of care.