Co‐existing mental health and substance use and alcohol difficulties – why do we persist with the term “dual diagnosis” within mental health services?

Abstract

Purpose -The term ''dual diagnosis'' has been widely accepted as referring to co-existing mental illness and substance misuse. However, it is clear from the literature that individuals with these co-existing difficulties continue to be excluded from mainstream mental health services. The term ''dual diagnosis'' can be pejorative and therefore, complicate or obstruct engagement. It is argued within this paper that the association between mental illness and substance misuse (including alcohol misuse) is an intricate and often a complex relationship involving a multitude of psychosocial factors that cannot be simply explained by an individual having two co-existing disorders. From this perspective, this paper seeks to argue that the term ''dual diagnosis'' should be actively de-emphasised.Design/methodology/approach -This paper offers a critique of ''dual diagnosis'' and the potential impact on access and treatment through discussion of the literature and reflections on service provision.Findings -The paper identifies five principles termed the ''5 key principles'', which support individuals with a wide spectrum of co-existing difficulties and to counteract the stigma often associated with the term ''dual diagnosis''. These collective principles allow the practitioner to consider the needs of the service user from the service user's perspective and therefore not be distracted by the perceived set of expected behaviours that are implied by the ''dual diagnosis'' label.Originality/value -This paper offers a critique of the term ''dual diagnosis'' and explores the impact of this in terms of service users and makes practical suggestions for alternative ways of conceptualising co-existing mental health and substance difficulties.

Closing the science-practice gap: introduction to the special issue on psychological interventions for comorbid addictions and mental health problems

“…more or less directive) and provision of their current situation. These principles are similar to those put forward by Guest and Holland (2011) for supporting individuals with complex presentations, reflecting best practice and expert advice in comorbidity treatment planning and delivery.…”

“…The co-existence of mental and substance use disorders (dual diagnosis) occurs in approximately 25-50 percent of substance users (Teesson et al, 2012), and is even higher when sub-threshold mental health symptoms are considered (Guest and Holland, 2011). Despite growing recognition and a rapidly increasing international evidence base for effective treatments, a serious level of unmet need for treatment exists for people experiencing dual diagnosis.…”

A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions

“…In addition to BFHJ, all offenders accessing Gateways are also provided with a peer mentor to meet them at the prison gate, and support to secure accommodation back in the community, in addition to help with finances, employment etc two areas of difficulties and contribute to the literature around the nature of 'dual diagnosis' (Guest & Holland, 2011;Hamilton, 2014). Rather than focussing purely on the substance misuse and mental health difficulties of prisoners, this study also attempted to make sense of these difficulties through understanding their relations to the experiences and events that have occurred in their lives, the other multiple and complex needs substance-involved prisoners might have (Rosengard et al, 2007), and how these issues may have impacted on their ability to terminate their substance misuse in the long-term.…”

“…The co-occurrence of substance misuse and mental health difficulties is often referred to as 'dual diagnosis', although, some have suggested that as a concept, dual diagnosis may not capture the full range of multiple and complex difficulties such individuals may experience (Guest & Holland, 2011) and therefore the range of needs that should be recognised and addressed in interventions for dually diagnosed individuals (McSweeney & Hough, 2006;Rutherford & Duggan, 2009). Such multiple and complex needs may include coming from a background of high social and economic deprivation, having been removed from biological parents and becoming a 'looked after child' within the care system, and having experienced periods of homelessness (Rosengard et al, 2007).…”

“…Although up to 45% of prisoners with identified substance dependence may have comorbid mental health issues such as anxiety or depression (Department of Health, 2009), the precise mechanisms by which substance misuse, mental health difficulties and offending may be associated with one another are still uncertain (Guest & Holland, 2011;Hamilton, 2014;Torrens et al, 2015). However, a number of causal mechanisms have been suggested, although there is still some disagreement in the literature.…”