Pathways through care for people with dual diagnosis in Europe: results from the treatment options for dual diagnosis user zoom instrument

Differences in care philosophies between the mental healthcare system and the substance misuse treatment system have a significant impact on treatment options for people with dual diagnosis. The aim of the study was to identify pathways through care for people with dual diagnosis in Europe using the Treatment Options for Dual Diagnosis User Zoom instrument. Declared pathways through care were categorised for 331 subjects with severe dual diagnosis recruited after admission to psychiatric wards at seven European sites and followed up over 9 months. At baseline, more than one in four subjects did not declare using either mental health or substance misuse centres or services. Mental health centres played the major role through follow-up with similar rates of declared use at all sites. By contrast, use of substance misuse treatment centres was half as frequent and varied considerably between sites. Declaring any use of substance misuse centres was generally associated with decreased overall contact with the mental healthcare system for this population of psychotic patients with comorbid substance misuse problems.