Purpose – This study is a post hoc service level investigation into the efficacy of a forensic dual diagnosis intervention. The treatment programme incorporated the principles of cognitive behavioural therapy and Motivational Interviewing, and was comprised of three stages: psycho-education into the links between mental/physical health, substance use and offending, the cultivation of coping strategies and relapse prevention planning. The paper aims to discuss these issues. Design/methodology/approach – Treatment outcome was tracked using pre- and post- stage 1 and 2 measures, and included self-report questionnaires that probed service users’ readiness for change, motivations for treatment and perceived effectiveness of coping strategies (n=80 and 37 patients for stages 1 and 2, respectively). In addition, service users undertook a knowledge “quiz”, which probed information retention. Findings – The results show that whilst psycho-education (stage 1) increased service users’ knowledge of key issues, this had no parallel effects on other measures. In contrast, completion of stage 2 led to an increase in external motivation for treatment, although this did not translate into a shift in service users’ readiness for change. Research limitations/implications – These findings are consistent with the Motivational Interviewing literature and highlight the need for a shift in internalised motivation for treatment if change is to be elicited. Further, they point towards the viability of using self-report measures to monitor treatment outcome in a secure forensic setting. Originality/value – These findings have a number of implications for the design and on-going evaluation of forensic dual diagnosis services, an area of research that is currently under-represented in the literature.

The lived experience of mentally disordered offenders with dual diagnosis was the focus of this study. Interviews with five recalled service users from a medium secure unit in England were subjected to an interpretative phenomenological analysis. Five themes were identified relating to identity, control, autonomy and recovery. Clinical implications include increasing service users' awareness of available post-diagnosis identities, which meet the needs of individuals' lived contexts and promotion of recovery-oriented care in forensic settings.

units using conventional outcome measures, and proposes alternative measures. Evaluating the effectiveness of interventions is important because of the ramifications of dual diagnosis for service user prognosis. Dual diagnosis is associated with poor treatment compliance, non-compliance with rules and regulations, failed conditional discharge and increased risk of relapse (Bellack & Gearon, 1998;Main & Gudjonsson, 2006). Dual diagnosis is also associated with re-admission (Carey & Correia,