24 Advances in Dual Diagnosis Q Volume 2 Issue 2 Q June 2009 © Pavilion Journals (Brighton) Ltd
The role of psychology
in enhancing dual diagnosis
provision in substance
misuse wards
identify a range of psychological difficulties.
Examples include anxiety, childhood trauma and
bereavement. An audit of referrals made in 2007–
2008 showed that 24% of clients were referred
for one psychological issue, 53% for two, and
23% for three or more.
Nature of client group
Clients admitted to SLaM substance misuse
wards for drug and/or alcohol detoxification or
drug stabilisation are a very diverse group, in
terms of age, background, reasons for drug and
alcohol use, and motivation to change. Ages
range from early 20s to mid-70s, with the average
age varying with drug of choice. For example,
crack cocaine users tend to be younger, and
dependent alcohol users tend to be in their 30s
or older. Ethnic and social backgrounds also vary,
reflecting the demographic profile of the south-
Introduction
The prevalence of mental health difficulties
in people with substance misuse problems is
extremely high. Weaver et al (2003) found
that 74.5% of drug service users and 85.5%
of alcohol service users had experienced mental
health problems, with depression and anxiety
disorders being the most common. Within
inpatient substance misuse wards, psychologists
can play an important role in promoting good
quality care provision for this group.
In our own service during the course of one
year, 38% (324/860) of all admissions to the
three substance misuse wards in South London
and Maudsley NHS Foundation Trust (SLaM) were
referred to the psychology team. Such referrals
can be made at the request of the client, the key
worker, the multidisciplinary management/ward
round, or the external referring agency. Referrals
Abstract
In this paper, we explore the role that psychology can play in enhancing dual diagnosis provision in substance
misuse wards. In order to understand what can be achieved, we will review: the nature of the client group
presenting to substance misuse wards; the role and function of such wards; the role of clinical psychology
within these wards; and specific issues relating to inpatient substance misuse treatment. We conclude by
identifying some key elements that we believe can enhance effective dual diagnosis working within inpatient
substance misuse services.
Key words
Psychology, substance misuse, ward, mental health.
Rob G Hill, Megan Underhill, Katherine Atnas and Jenny C Harris
South London and Maudsley NHS Foundation Trust
PRACTICE