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Rehabilitation for people with dual diagnosis (co-existing mental illness and substance dependence) has existed in many forms over the past thirty years and has become more urgently needed over time. Treatment for this population inevitably requires a team effort (Schwartz & Lehman, 1998). These people are difficult to engage in treatment and it takes time to unravel the interacting effects of substance abuse and their mental illness. Social relationships may also be problematic, particularly once the person has decided to discontinue drug or alcohol abuse. Often such clients find it easier to communicate socially with people who have similar problems (Hatfield, 1993). Improvements in self-esteem and reduced intake of drugs and alcohol are rarely monitored in the one community psychiatric facility, as in this study. The method of treatment in this case was to run a small group for participants over an extended period with support from multidisciplinary teams, using a Dutch model for drug and alcohol rehabilitation. By targeting psychiatric relapse prevention and people's life stories, using a biographical developmental framework and dramatherapy interventions, the intention was to achieve outcomes of higher self esteem and reduced intake of recreational drugs. In fact the pre and post measures chosen did not show significant variance. For all participants, including those who were already abstinent, changes in lifestyle and achievement of life goals were sought. As a result, there was reported enjoyment of mutual support, sharing and understanding of individual life stories, together with strategies to increase resilience. Further research is needed to identify how best to measure outcomes. Hatfield, A. (1993) ‘Dual Diagnosis and Mental Illness’, Journal of National Alliance for the Mentally Ill, (Online), retrieved 11.1.08 Schwartz, R. & Lehman, A. (1995) in ‘Overview of Treatment Principles’ in Lehman, A. & Dixon, L. (eds.) Double Jeopardy, Harwood Academic Publishers, Chur, Switzerland, p.77

Dramatherapy lends itself seamlessly to a person-centred approach, particularly important for elderly people who are nearing the end of their lives. The dramatherapy group affords a holding environment where existential issues and key life questions can be worked with creatively. Although their expression may sometimes seem chaotic (as in dementia), elderly people are often the guardians or holders of much end-of-life wisdom. By means of story, metaphor, play and improvisation, cultural questions and answers can assist with celebration, reminiscence, pleasure and grieving, and ultimately the transition to a dignified and spiritually meaningful death. In this way, the spirituality of the person with dementia can be explored and accepted. Spirituality has informed theatre and drama throughout history, and the healing properties of the arts are referred to in the histories of many societies. In contemporary western culture, especially that of the last 50 years, there has been a growth of consciousness that creative activity can contribute to people's health and well-being and that the area of spirituality is integral, and perhaps even central, to psycho-social health and a sense of well-being. In this paper, selected dramatherapy literature is reviewed, that supports the contention that the practice of these therapies is an effective means of assisting elderly people afflicted with moderate-to-severe dementia to value their ageing process. Arts therapies may assist them to cope with the grief and loss their ageing may entail, as they lose friends and physical and mental capacity, in a society where elderly people are marginalised. Case studies and theoretical examples are presented to show how group work can be structured so that issues of elderly people with dementia can be addressed in a creative way.

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