Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment

Abstract

Background: While many studies have examined the prevalence of concurrent substance misuse and mental health problems across different treatment populations, we know little as to what extent such co-morbidity is identified in routine clinical practice. However, literature in the field has emphasised the importance of recognising co-morbidity early to avoid adverse treatment outcomes.

Aims: To determine: (1) the degree to which co-morbidity is recognised and addressed in outpatient addiction services; and (2) whether unaddressed co-morbidity increases the risk of dropout.

Method: Clients (n = 176) starting treatment at six UK-based drug and/or alcohol services and their 46 practitioners were followed for 3 months. Multiple assessments were carried out in order to obtain information about clients' mental health, 90-day retention rates, treatment perceptions and practitioners' expertise and training levels in the co-morbidity field. Services' assessment protocols and in-treatment case notes for each client were examined.

Results: Of 124 (71%) clients screening positive for mental health problems, services recognised co-morbidity in only 54%, and addressed it in 23%. Clients whose co-morbidity was not addressed were significantly less likely to be retained at 90 days (HR = 0.296, p < 0.005).

Conclusions: Improving assessment and care planning procedures is important because of a link between unaddressed co-morbidity and dropout.

Keywords:

• assessment
• co-morbidity
• drug/alcohol treatment
• dual diagnosis
• mental health
• retention

Acknowledgements

This study forms part of a PhD project, which was funded by a Manchester Metropolitan University Studentship. Sincere thanks go to all clients and staff at the participating treatment programmes.