Effectiveness Bank web site Mental health
Supported by   Society for the Study of Addiction web site   Alcohol Change UK web site  

Substance use and mental health problems: which is chicken, which is egg, and does it matter?
There has been a preoccupation in the literature and in practice about which comes first, the substance use issue or mental health issue…With the vast majority of their clients also experiencing mental health problems, deciding how to respond is a major concern for Britain’s drug and alcohol services.

Should substance use services take the lead in coordinating their clients’ care, or should this be taken on by mental health services? Is either willing and able to take on both issues, or would a better option be to create new integrated services?
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UPDATED HOT TOPIC The complexity and challenge of ‘dual diagnosis’
People with coexisting mental health and substance use problems often have high support needs and poor treatment outcomes. A hot topic updated with links to new resources explores barriers to the provision of appropriate support, as well as the many opportunities and occasions to improve the lives of those affected.

What would better mental health and substance use care look like?
According to Public Health England, better care for people with co-occurring mental health and substance use problems begins with commissioners and service providers adopting the principles that there is ‘no wrong door’ for accessing support, and it is ‘everyone’s job’ the other side of the door to help.

NICE advises against specialist dual diagnosis services
Guidance from the UK’s National Institute for Health and Care Excellence says that rather than creating specialist ‘dual diagnosis’ services, health and social care (including substance use) services should adapt to patients with substance use problems and severe mental health problems, and collaborate in their care, led by the mental health service.

Evidence, experience, and orthodoxy – pillars of UK drug treatment
There is no more important document for doctors treating problem drug use in the UK than the so-called ‘Orange guidelines’. Given the high prevalence of comorbid problems in all drug and alcohol services and all mental health services, guidance states that suitable interventions are needed for substance problems in all mental health services and for mental health problems in all substance use services, with competent staff available to deliver such interventions.

Psychosis and substance use
Substance use tends to worsen outcomes for people with psychosis partly because the substances used can exacerbate the psychosis, and partly because they can interfere with pharmacological or psychological treatment. How should problems relating to psychosis and substance use be dealt with, and what are the respective roles of mental health and substance use services? UK guideline developed by an expert group has some answers to among the most difficult questions in substance use treatment.

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Hot topics – important, controversial, dividing opinion over facts or interpretation.

The Drug and Alcohol Findings Effectiveness Bank offers a free mailing list service updating subscribers to UK-relevant evaluations of drug/alcohol interventions. Findings is supported by the Society for the Study of Addiction and Alcohol Change UK, and advised by the National Addiction Centre.