BackgroundThe aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD).MethodsWe examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings.ResultsAcross the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed.ConclusionsHigh satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients.

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Background: Dually diagnosed clients are described as one of the most challenging treatment populations, often leading to staff frustration, helplessness and negative attitudes. As yet it is unclear whether dual diagnosis (DD)-specific competency and therapeutic optimism among staff are related to client outcomes. Methods: The study used a 3-month follow-up design involving 124 DD clients starting treatment at 6 UK addiction services. Practitioners (n = 46) treating these clients were assessed regarding their DD specialisation levels. Cox regression analyses were performed to examine predictors of clients’ 3-month retention rates. Results: Staff reported a median of 7 years work experience with DD clients, and 80% had received co-morbidity-specific training. Practitioners provided high average ratings on both the DD competency and the therapeutic optimism scale. Nevertheless, 78% of the sample indicated additional support needs in dealing with this client group. Higher levels of DD competencies among staff predicted better client retention. Conclusion: The increased provision of support packages for practitioners is vital for improving competency levels in dealing with DD clients, which in turn may lead to improved client outcomes.

AimsTo investigate the existing level of user involvement at selected agencies, to examine views about user involvement from both service user and provider perspectives and to compare desired service developments. Setting Community-based drug services in Northern England. Design/MeasurementsParticipants Forty-six service users and 51 service providers.Findings The level of service user involvement was low overall, with 16% of services having no user involvement at all. Nevertheless, service users expressed a desire for a high level of user involvement, compared with the low aspirations expressed by service providers. Service users' first priority for desired service developments was reduced waiting times, whereas service providers wished for increased provision of complementary therapies. ConclusionsThe study highlights important discrepancies regarding both desired level of user involvement and priorities for service developments between service users und providers. Given the current policies in this field and evidence that user involvement and closer partnerships between users and providers enhances treatment effectiveness, this lack of concurrence might be of major concern and working towards better understanding and balancing users' and providers' needs is highly recommended.