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This article explores the social context, prevalence and treatment of problems related to dual diagnosis in the countries of Eastern Europe, drawing on an extensive literature search as well as the authors' wide personal experience of working with mental health reformers in policy, education and service delivery in most countries in the region. It describes the region's historical and societal background, and sets out basic epidemiological information, including the rate and impact of mental illness and alcohol and substance abuse. It reviews what services are available for people with dual and triple diagnosis; outlines the barriers to progress; and makes recommendations for improvements.