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This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings.

In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model.

These changes were:

• Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients.

• To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services.

• Introduction of substance misuse workers as team members on acute mental health and rehab wards.

• Group Substance Misuse programmes.

Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances.

Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

Despite Policy Statements and abundant evidence of the particular needs and problems of those with a dual diagnosis of mental health problems and substance misuse, very little that is effective is being done for this group. The paper reviews the evidence and considers some of the solutions proposed.

Dual diagnosis (DD) has become a challenging therapeutic issue of our time. As a substance misuse practitioner, I, like many of my colleagues have often been frustrated with the difficulties that service users face in trying to address their issues, often being bounced between services that are unable to meet their needs. This article looks at some of the challenges that face staff working in both substance misuse services and mental health services as they work to deliver services to a group of service users with multiple and complex needs. It will look at the way in which we define dual diagnosis, the challenges that face both services and service users, how new government guidance could impact upon improved working practice and outcomes in the future and what some of the barriers are to the successful implementation of this guidance.

Alcohol misuse leads to a massive drain upon an already stretched NHS budget. High numbers of individuals with alcohol related physical and health needs are being admitted into the secondary health care setting at great financial cost. This paper examines a profile of this population presenting to the secondary care setting over a 12‐month period. It is suggested that the misuse of alcohol does not take place in isolation. It is often accompanied by other problematic behaviours such as domestic violence, inappropriate, neglectful parenting, or child abuse, offending behaviour, and psychological problems. Evidence for the nature and extent of these associated behaviours is reported and discussed. Comparisons are made particularly with data related to tobacco smoking, and the positive aspects of smoking cessation programmes are outlined. Almost all of the population reported on over the 12‐month period were tobacco smokers. The re‐emergence of the incidence of smoking with the reduction of smoking cessation programmes is noted. The challenge for substance misuse services is how best to respond to the needs of this growing population who often present withalcohol misuse together with smoking behaviours. A collaborative model of response is outlined and suggested as the best way forward. This involves substance misuse services working together with professional colleagues within the acute hospital environment and community to ensure sustainable positive clinical outcomes following hospital discharge.

The purpose of this paper is to examine the extent to which the two visions of recovery that are now being developed in the UK are consistent with each other and question what impact the development of parallel approaches will have on people at the intersections between them.

The paper looks first at the origins and current implementation of the two approaches and then examines the commonalities and differences in the context of what they might mean for people using both sets of services simultaneously.

The ideas behind Recovery in mental health and substance misuse services have some differences but significant common ground in focusing on improving quality of life.

This paper points to the need to understand recovery in both services from the perspectives of those who have a dual diagnosis and need support from each service.

This paper could be used to develop new approaches to supporting people with a dual diagnosis with a consistent Recovery focus.

Placing personal recovery at the heart of both mental health and substance misuse services may, over time, improve their efficiency and effectiveness.

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.

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.

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.

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.

Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey.

Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis.

Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”.

The research excluded people who recover outside of services, replicating a shortcoming of much research in this area.

The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working.

The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population.

This paper proposes a model for a dual diagnosis service within a male local prison. Dual diagnosis can be considered usual rather than exceptional within the establishment and indeed within the prison estate. For a variety of reasons, it is found that effective dual diagnosis service delivery represents core business for a range of stakeholders. The dual diagnosis definition preferred is ‘a mental disorder and substance misuse problem in the same person at the same time’. Analysis of the strengths of current service provision and the risks to the development of a new service model are explored through a strengths, weaknesses, opportunities and threats (SWOT) analysis. Current literature and policies inform the model, and it is concluded that a dual diagnosis service can be implemented mostly within existing resources. An implementation schedule highlights one such pathway. Stakeholders were consulted and generally found to be receptive.

Noting that a fundamental tenet of service‐dominant (S‐D) logic is the co‐creation of value‐in‐use, this paper aims to explore the theoretical possibility that the interactions between service systems cannot only co‐create value, but also have adverse consequences leading to actual value co‐destruction.

This conceptual paper critically reviews the dominance of value co‐creation and value‐in‐use in S‐D logic. Noting the relative lack of research in the converse possibility, the study proposes and explores the implications of value co‐destruction as a new concept which should be introduced within the framework of S‐D logic.

The study proposes a formal definition for the new proposed concept of value co‐destruction. It describes in detail the process by which it occurs, showing that value can be co‐destroyed through the interactions between different systems, resulting in value destruction‐through‐misuse. Indeed, value co‐destruction occurs when a service system accidentally or intentionally misuses resources (its own resources and/or those of another service system) by acting in an inappropriate or unexpected manner.

This paper is purely conceptual and exploratory. Empirical examination of the theoretical findings regarding value‐co‐destruction is required. Possible avenues of interest for such empirical research of value co‐destruction are suggested.

Limiting the occurrence of misuse by aligning the mutual expectations of interacting service systems should reduce the risks of value co‐destruction. Recovering from misuse should also be considered.

This study is apparently the first to have introduced the notion of value co‐destruction into the conceptual framework of S‐D logic.