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Integrated treatment of dual disorders in The Netherlands: a qualitative study of client experiences

Anneke van Wamel (Trimbos Institute, Program Care and Participation, Utrecht, The Netherlands)
Ankie Lempens (Trimbos Institute, Program Care and Participation, Utrecht, The Netherlands)
Arjen Neven (Centre for Dual Disorders (CDP), Fivoor, Den Haag, The Netherlands)

Advances in Dual Diagnosis

ISSN: 1757-0972

Article publication date: 9 July 2021

Issue publication date: 29 November 2021




Many clients who suffer from severe mental health problems also struggle with alcohol and drug use. And although there seems to be a consensus in most European countries that integrated treatment models (especially the integrated treatment of dual disorder clients model) are best fitted to help these clients, none of these have strong evidence, mostly owing to methodological limitations in the studies. This study aims to contribute to the knowledge of why integrated treatment is helpful by conducting in-depth interviews with dual disorder clients who are currently receiving integrated treatment.


This study is a qualitative thematic analysis using a timeline tool to elicit participants’ responses. In the interviews, dual diagnosis clients with severe problems reflected on their situation at admission, the care they received in integrated treatment and their opinions on positive and negative elements. The interviews were coded and analysed with MAXQDA.


In the analyses of the interviews, this study found three clusters of elements that clients indicated were the most helpful during their treatment and recovery process: trusting and meaningful relationship with the team, components of integrated treatment and organisation of care.


The findings emphasized the importance of working relationship in the treatment of complex and long-term problems. This has implications for the evaluation of these integrated treatment models which so far mainly focuses on specific interventions.



This project is funded by the five Dutch mental health organisations Fivoor, Emergis, GGzE and the Kempen, GGZ West North Brabant and VOF Dubbele Diagnose, who together with the Trimbos-institute form the National Centre of expertise in Dual Disorders (LEDD). The authors acknowledge the cooperation and openness of the clients we interviewed, and the team members for their help in organising of and participating in the sessions. Authors would also like to thank Avans Hogeschool, all the interviewers for their help and commitment and Patrick Boyle for proofreading the final manuscript.


Wamel, A.v., Lempens, A. and Neven, A. (2021), "Integrated treatment of dual disorders in The Netherlands: a qualitative study of client experiences", Advances in Dual Diagnosis, Vol. 14 No. 4, pp. 183-197.



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