Integrated treatment approaches for co-occurring mental health and substance use disorders: findings from a survey of European healthcare providers

Abstract

Objectives: Dual disorder, comprising of substance use and mental health disorders, requires a comprehensive treatment approach. The most effective is integrated dual disorder treatment, which involves addressing both conditions concurrently by the same specialists and in the same setting. This study examines characteristics of integrated dual disorder care offered by treatment services across European countries. Methods: In 2022, representatives of 14 integrated care for dual disorder providers in 10 European countries were asked to respond to a survey about their treatment process, outcomes, barriers and facilitators when implementing dual disorder treatment in respective countries. Thematic qualitative analysis was used to explore closed- and open-ended responses, focusing on commonalities and differences between surveyed services. Results: Integrated care services varied in treatment settings and structure, but all offered comprehensive support for dual disorder. Among 14 services, half addressed tobacco addiction or provided suicide prevention, three treated cannabis use, and none accepted patients in opioid agonist therapy. Few services reported evaluating treatment outcomes in standardised way. Services supported patients with social security, employment, housing and education, but also noted difficulties in coordinating post-treatment care due to divergent views on dual disorder among specialists from different services. Conclusions: Integrated care services provide comprehensive and tailored support for people with dual disorder but remain distinct within the healthcare options available to this patient group across Europe. Existing and future integrated care services would benefit from addressing tobacco and cannabis use, measuring treatment outcomes and improving continuity of care.