Purpose Older adults with cognitive impairment who drink too much alcohol risk further cognitive decline and other alcohol-related harms. The purpose of this study was to review the literature to synthesise existing knowledge about modifications to alcohol screening and brief interventions for people with cognitive impairment and their effectiveness. Design/methodology/approach We carried out a systematic review (PROSPERO: CRD42022378827). We included studies of older adults with cognitive impairment that examined alcohol screening or brief interventions applied to or modified for this group. A narrative synthesis was conducted. Findings Four studies (5 papers) were found that met the review inclusion criteria. Alcohol screening tools and brief interventions were reported to be acceptable and feasible in older people with cognitive impairment (2 studies). No studies of the effectiveness of alcohol screening or brief interventions for people with cognitive impairment were identified. Research limitations/implications Research should focus on the development of modified interventions that should be tested rigorously to tackle the large and growing burden of cognitive impairment globally. Originality/value This original systematic review found no studies exploring the effectiveness of alcohol screening or brief interventions modified for people with cognitive impairment, though studies indicated they are considered feasible and acceptable in this population.
Purpose Addiction and personality disorders often co-occur. Although integrated treatment is advised, it is rarely applied. The purpose of the current paper is to describe a day treatment program in which such an integrated treatment is deployed. The goal is to inform clinicians in the field. Design/methodology/approach The guiding principles in this treatment program as well as the methods (cognitive behavioural therapy, schema therapy, group psychotherapy) and procedures of the program are outlined. Findings When offered in a methodical way, integrated treatment for addiction and personality disorders appears to be a promising treatment option. Originality/value A day treatment program for addiction and personality disorders using schema therapy has not been described before.
Purpose The purpose of this paper is to examine recovery through lived experience. It is part of a series that explores candid accounts of addiction and recovery to identify important components in the recovery process. Design/methodology/approach The G-CHIME model comprises six elements important to addiction recovery (Growth, Connectedness, Hope, Identity, Meaning in life and Empowerment). It provides a standard against which to consider addiction recovery. It has been used in this series, as well as in the design of interventions that improve well-being and strengthen recovery. In this paper, a first-hand account is presented, followed by a semi-structured e-interview with the author of the account. Narrative analysis is used to explore the account and interview through the G-CHIME model. Findings This paper shows that addiction recovery is a remarkable process that can be explained using the G-CHIME model. The significance of each component in the model is apparent from the account and e-interview presented. Originality/value Each account of recovery in this series is unique, and as yet, untold.
Purpose The purpose of this paper is to examine recovery through lived experience. It is part of a series that explores candid accounts of addiction and recovery to identify important components in the recovery process. Design/methodology/approach The G-CHIME model comprises six elements important to addiction recovery (Growth, Connectedness, Hope, Identity, Meaning in life and Empowerment). It provides a standard against which to consider addiction recovery. It has been used in this series, as well as in the design of interventions that improve wellbeing and strengthen recovery. In this paper, a first-hand account is presented, followed by a semi-structured e-interview with the author of the account. Narrative analysis is used to explore the account and interview through the G-CHIME model. Findings This paper shows that addiction recovery is a remarkable process that can be explained using the G-CHIME model. The significance of each component in the model is apparent from the account and e-interview presented. Originality/value Each account of recovery in this series is unique and as yet untold.
PurposeThis paper critically aims to examine how the co-occurrence of mental health conditions and substance use, commonly referred to as dual diagnosis, is addressed within Australian custodial settings. Design/methodology/approachGrounded in an abolitionist framework, it explores how prisons routinely rely on solitary confinement to manage drug withdrawal and psychological distress, compounding harm for those with complex health needs, with a particular focus on women. FindingsThe structural exclusion of incarcerated people from Medicare and the Pharmaceutical Benefits Scheme plays a central role in limiting access to essential care, including mental health plans, chronic disease management and affordable medication. Without access to a specialist of their choice, and with significant barriers to services like the National Disability Insurance Scheme and aged care, people in prison are routinely denied care equivalent to what is available in the community. Women with dual diagnosis are particularly impacted – often exiting prison in worse physical and mental health than when they entered, placing them at heightened risk of re-incarceration. Originality/valueThis paper argues that prison environments reproduce and intensify the very conditions they claim to address, and calls for the dismantling of carceral responses to mental distress and drug use in favour of community-based approaches rooted in dignity, collective care and social justice.
PurposeThis study explores perspectives of mental health and addiction healthcare workers, clinical leaders, and lived experience advocates on training requirements for integrated care delivery in Victoria, Australia. We identify key knowledge domains that support workforce development to enhance integrated service delivery for people with co-occurring mental health and alcohol and other drug (AOD) disorders.Design/methodology/approachIn 2022, online co-design workshops were conducted using the Tactile Tools digital workshop method with 50 participants in Victoria, Australia. Data based on four case study "personas" were analysed using qualitative thematic analysis with multiple participant groups, enabling validation through triangulation.FindingsAnalysis generated five workforce development themes: (1) foundational knowledge relating to role clarity, system navigation, stigma reduction; (2) workforce-specific training needs; (3) preference for face-to-face, collaborative learning; (4) necessity of organisational support alongside individual training and (5) emphasis on practical skill development balancing specialist and generalist knowledge.Practical implicationsTraining activities should incorporate cross-disciplinary experiences, address organisational barriers, engage leadership and prioritise relationship-building. Workforce development should focus on practical skill-building through targeted workshops and cross-sector placements.Originality/valueThis study offers a unique examination of integrated care workforce development from healthcare workers' perspectives. It highlights the interplay between individual training and organisational context, revealing that role clarification and addressing stigma must precede the development of technical skills. The findings emphasise relationship-based learning over content acquisition.
PurposeThis study aims to synthesize empirical evidence on the impact of physical activity and social support on clinical outcomes in adults with dual diagnosis, including psychiatric symptoms, substance use, craving and quality of life.Design/methodology/approachThe review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251041091). Searches were conducted in PubMed, Scopus, Web of Science and PsycINFO for studies published between January 2014 and April 2025. Eligible studies were randomized or quasi-experimental trials involving adults with co-occurring mental and substance use disorders (SUDs) who received structured physical activity or social support interventions. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the certainty of evidence was evaluated with GRADE. Given study heterogeneity, results were synthesized narratively.FindingsSixteen randomized controlled trials were included, covering diverse populations with mood, psychotic and trauma-related disorders. Physical activity interventions - particularly high-intensity or structured programs - showed significant reductions in craving, depressive and anxiety symptoms and substance use frequency. Social support interventions improved treatment adherence, emotional regulation and perceived well-being, though effects on social functioning were more variable. Combined interventions integrating both components produced the most consistent improvements across outcomes. Certainty of evidence was rated as moderate for psychiatric symptoms and substance use, and low for craving and social functioning due to heterogeneity and imprecision.Research limitations/implicationsThis review was limited by the heterogeneity of interventions, outcome measures and study populations, which prevented quantitative synthesis. Some included studies had small samples and moderate risk of bias. Follow-up durations were generally short, and few trials evaluated long-term effects. Despite these limitations, the review provides a comprehensive synthesis of recent evidence. Future studies should use larger, multicenter samples and standardized intervention protocols to clarify causal mechanisms and strengthen the evidence base for physical activity and social support as adjunctive strategies in dual diagnosis rehabilitation.Practical implicationsThe findings support integrating structured physical activity and enhanced social support into treatment programs for adults with dual diagnosis. These interventions can complement pharmacological and psychotherapeutic approaches, improving adherence, emotional regulation and relapse prevention. Their low cost and scalability make them feasible in both inpatient and community settings. Mental health professionals should consider individualized, culturally adapted programs that align with patients' motivation and capacity, fostering sustainable recovery and quality of life improvements in clinical practice.Social implicationsIndividuals with dual diagnosis often face stigma, marginalization and limited access to social networks. Interventions that promote physical activity and social connectedness may reduce isolation, enhance self-efficacy and rebuild interpersonal trust. Encouraging participation in structured group activities and peer-based programs can strengthen community reintegration and social functioning. These strategies contribute to greater inclusion and autonomy, supporting recovery-oriented approaches in mental health services for people with cooccurring psychiatric and SUDs. Originality/valueThis review is the first to synthesize evidence from randomized controlled trials on the combined impact of physical activity and social support in dual diagnosis. It highlights the potential of nonpharmacological, person-centered interventions as protective factors that enhance mental health outcomes and quality of life. The review provides evidence to inform integrative and rehabilitative treatment approaches tailored to the needs of this underserved population.
PurposeIncreasingly, the value of peer-led programmes to support individuals with co-occurring mental health and substance use disorders (dual diagnosis) is acknowledged. However, there is a lack of validated tools to assess meaningful engagement in these programmes. This study aims to develop and validate the Meaningful Engagement Evaluation Tool (MEET) to measure engagement in dual-diagnosis peer-led support groups systematically.Design/methodology/approachUsing a co-designed approach, MEET was developed in collaboration with consumers, peer facilitators and clinicians. The tool consists of two scales - one for consumers and one for facilitators - measuring four key engagement domains: hope and motivation, social connection, recovery strategies and safe space. The study was conducted across six public health service sites, with survey data collected from 410 consumers and 384 facilitators. The quantitative analysis assessed internal consistency, while qualitative responses were thematically analysed.Findings MEET demonstrated strong internal consistency (Cronbach's alpha = 0.82 for consumers, 0.88 for facilitators). Participants reported high engagement, with qualitative themes highlighting the role of lived experience in fostering connection and recovery. Item responses encountered ceiling effects.Research limitations/implicationsThis study demonstrated that the MEET is a reliable tool for assessing engagement in peer-led dual-diagnosis programmes; however, several limitations were identified. Quantitative data showed ceiling effects, limiting discrimination between high engagement levels. The predominantly mental health-based sample and limited inclusion of alcohol and drug services constrain generalisability. Broader validation, refinement of item wording and enhanced scale sensitivity are needed. Findings highlight MEET's potential for improving programme evaluation, with future research recommended to optimise measurement precision and test applicability across diverse peer-led settings.Practical implicationsThe MEET provides mental health and alcohol and other drug (AOD) services with a co-designed, reliable tool to evaluate meaningful engagement in peer-led dual-diagnosis programmes, capturing dimensions such as hope, social connection, recovery strategies and safe space. Its use can guide service improvement, highlight the value of lived experience facilitation and strengthen evidence for peer work within integrated care models. By providing structured, participant-centred feedback, MEET supports quality improvement, programme funding justification and alignment with recovery-oriented practice. Future refinements to increase sensitivity will enhance its utility, enabling services to better tailor interventions, demonstrate impact and promote engagement across varied clinical and community settings.Social implicationsThe MEET reinforces the social value of peer-led dual-diagnosis programmes by evidencing their role in fostering inclusion, trust and mutual support among people with lived experience. By capturing participants' perceptions of hope, connection and safety, it highlights how such programmes reduce stigma, promote empowerment and build recovery capital through shared experiences. Widespread use of MEET can strengthen recognition of peer work as a legitimate and impactful component of mental health and AOD services, supporting policy shifts towards recovery-oriented care. Ultimately, this tool can help embed lived experience perspectives into service design, enhancing social cohesion and equity in health systems. Originality/valueThe MEET is a reliable and valid measure of engagement in peer-led dual-diagnosis programmes. Future research should further refine MEET and assess its applicability across diverse recovery settings.
PurposeForensic mental health services care for individuals with mental disorders involved in the criminal justice system. Rates of co-occurring substance-use disorders (dual diagnosis) in this population is high, and addressing substance use in treatment is vital, but limited staff knowledge and negative staff attitudes can hinder care. This study, a systematic review, aims to understand the attitudes, perceptions and knowledge of clinical staff regarding substance use as well as its treatment within the forensic setting.Design/methodology/approachA comprehensive database search of PubMed (containing Medical Literature Analysis and Retrieval System Online), PsycINFO and Cumulative Index to Nursing and Allied Health Literature was conducted in February 2025 using keywords associated with the topic question. Studies were selected based on inclusion and exclusion criteria. The quality of included studies was assessed using the Joanne Briggs Institute critical appraisal tool.FindingsA total of 12 studies were included in the final review. Findings showed that substance use and dual diagnosis work remains a significant challenge in forensic settings due to security constraints, staff training gaps and persistent stigmatising attitudes. Addressing these issues is essential for better treatment provision.Originality/valueThis is the first systematic review exclusively and comprehensively exploring clinical staff attitudes, perspectives and knowledge regarding substance use and its treatment in the forensic setting. Findings will help to guide the implementation of future substance-use and dual diagnosis treatment and training programmes in forensic settings.
PurposePeople in custody experience disproportionately high rates of post-traumatic stress disorder (PTSD) yet the impact of this on criminogenic needs and recidivism remains unclear. This study aims to examine the prevalence of PTSD, associations with criminogenic needs and reoffending and the role of alcohol use in these associations among adults in custody.Design/methodology/approachData were drawn from a linked dataset combining health (data collected in 2015), correctional and reoffending records for 1,033 incarcerated individuals in Australia. Two-way ANOVAs were conducted to examine the effects of current PTSD and hazardous alcohol use, and their interaction, on criminogenic needs. Regression models were used to examine associations between current PTSD, hazardous or dependent drinking in the 12 months before prison and their interaction in predicting both any and violent reoffending within the first 12-month following release from custody.FindingsMost participants were male (66.9%), mean age 35.57 (SD = 11.6) and 15.9% meeting criteria for current PTSD. Two in five participants (43.8%) exceeded the threshold for hazardous alcohol use prior to incarceration, with 28% meeting criteria for alcohol dependence. PTSD and hazardous alcohol use were independently associated with higher criminogenic needs. Hazardous alcohol use, but not PTSD, was associated with greater odds of, and a shorter time to violent reoffending. There was no evidence of any association between PTSD and reoffending.Originality/valueThis study addresses a critical gap by examining the prevalence and impact of PTSD and hazardous alcohol use, both independently and in combination, on criminogenic needs and reoffending outcomes among incarcerated adults.
PurposeSubstance use disorders (SUDs) are prevalent in forensic mental health hospitals, complicating rehabilitation and safety. Despite this, little is known about the extent of ongoing substance use. This study aimed to determine the prevalence of SUDs, investigate unauthorized substance use during admission and identify associated risk factors within a secure forensic mental health hospital.Design/methodology/approachThis retrospective study reviewed medical records of 95 inpatients at an Australian forensic mental health hospital. Patient characteristics were compared between those who used unauthorized substances during admission and non-users, with multiple logistic regression modeling used to identify key predictors.FindingsA diagnosis of SUD was present in 73% of patients. During admission, 43% used unauthorized substances, with 29% using illicit substances. Individuals who engaged in substance use had a significantly higher prevalence of SUD history, intravenous drug use and diagnoses of personality disorders when compared to non-users. They were also more likely to be younger, Australian-born, have a longer hospital stay and be admitted to a lower secure unit. Stimulant use disorder was a predictor for any unauthorized substance use, while longer length of stay was strongly associated with substance use. Predictors for illicit use additionally included cannabis use disorder and the diagnosis of a personality disorder.Originality/valueThis study confirms the high prevalence of SUDs and ongoing substance use occurring within forensic mental health hospitals, highlighting the need to develop targeted clinical interventions. The findings are discussed considering how they inform risk management and policy development in forensic settings.
PurposeThe purpose of this paper is to examine recovery through lived experience. It is part of a series that explores candid accounts of addiction and recovery to identify important components in the recovery process.Design/methodology/approachThe G-CHIME model comprises six elements important to addiction recovery (growth, connectedness, hope, identity, meaning in life and empowerment). It provides a standard against which to consider addiction recovery. It has been used in this series, as well as in the design of interventions that improve wellbeing and strengthen recovery. In this paper, a firsthand account is presented, followed by a semi-structured e-interview with the author of the account. Narrative analysis is used to explore the account and interview through the G-CHIME model.FindingsThis paper shows that addiction recovery is a remarkable process that can be explained using the G-CHIME model. The significance of each component in the model is apparent from the account and e-interview presented.Originality/valueEach account of recovery in this series is unique, and as yet, untold.
Purpose The purpose of this paper is to examine recovery through lived experience. It is part of a series that explores candid accounts of addiction and recovery to identify important components in the recovery process. Design/methodology/approach The G-CHIME model comprises six elements important to addiction recovery (growth, connectedness, hope, identity, meaning in life and empowerment). It provides a standard against which to consider addiction recovery. It has been used in this series, as well as in the design of interventions that improve wellbeing and strengthen recovery. In this paper, a first-hand account is presented, followed by a semi-structured e-interview with the author of the account. Narrative analysis is used to explore the account and interview through the G-CHIME model. Findings This paper shows that addiction recovery is a remarkable process that can be explained using the G-CHIME model. The significance of each component in the model is apparent from the account and e-interview presented. Originality/value Each account of recovery in this series is unique, and as yet, untold.
PurposeThis study aims to evaluate the effectiveness of the Anglicare Victoria Inreach Integrated Model of Care in enhancing collaboration between mental health and alcohol and other drug (AOD) services. It focuses on improving patient outcomes during and after inpatient psychiatric admissions, examining referral patterns, engagement and readmission rates.Design/methodology/approachA retrospective exploration of clinical and quality assurance data was conducted, analysing 571 referrals made from inpatient psychiatric units (IPUs) to the Anglicare Victoria Inreach service between July 2020 and December 2023. Quantitative data sets such as demographics, engagement rates and 28-day readmission rates were reviewed. A t-test was used to assess differences in 28-day readmission rates between consumers who did and did not receive Anglicare Inreach services.FindingsOf the 7,130 IPU admissions, 8% were referred to the Anglicare Victoria Inreach service, with 93% of consumers engaging in post-discharge support. The 28-day readmission rate for those who received Anglicare Inreach services was higher (M = 20.4%) than those who did not (M = 15.1%), though this difference did not reach a level of statistical significance (p = 0.051). Alcohol and methamphetamine were the most prevalent substances of concern, while mood disorders were the most common mental health diagnoses of Anglicare consumers.Originality/valueThis study offers valuable insights into the functioning of an integrated care model bridging mental health and AOD services. Although high engagement rates were observed, the elevated readmission rates highlight the need for further research to assess the long-term effectiveness of such integrated models in addressing co-occurring mental health and substance use issues.
PurposeThis paper aims to investigate the occurrence and management of alcohol and other drugs (AOD) and mental health problems among women who have initiated a recovery process after treatment, focusing on how the recovery processes from these problems relate to each other over time.Design/methodology/approachThirty women were interviewed three times over a 10-year period. All women had undergone treatment for AOD problems. Trajectories of both AOD use and experiences of mental health problems, based on the women's own descriptions, were analyzed.FindingsThe results are presented in flowcharts that show heterogeneous trajectories for these problems and how they relate to each other. A qualitative analysis further reveals that remaining and sometimes reoccurring problems are interpreted differently over time. This implies that the need for support varies both with the type of problem and in relation to other contextual factors during the life course.Originality/valueThe results generate new knowledge about how recovery processes from AOD and mental health problems in women relate to each other over time, from a first-person perspective.
PurposeThis paper aims to research the barriers that staff in low-threshold facilities experience when they try to facilitate contact with the psychiatric treatment system on behalf of people who are marginalized and use drugs (PMUD) and suffer comorbid mental health problems.Design/methodology/approachThis is a qualitative, phenomenologically inspired study based on in-depth interviews with 15 frontline staff members working at different low-threshold facilities in the open drug scene in Copenhagen. Analysis is inspired by systematic text condensation, and this paper used an analytical framework that divides barriers into those generated by personal characteristics and structural barriers.FindingsStaff experience both types of barriers when they try to facilitate contact with the psychiatric treatment system on behalf of PMUD. Personal characteristic barriers include client worries about having to make it without drugs if admitted to a psychiatric ward and about being subject to coercion, experiencing discrimination by staff and paranoia about the system. Structural barriers include a psychiatric treatment system that lacks commitment and flexibility, with a focus on acute conditions.Originality/valueThis study provides in-depth knowledge about the specific barriers in the psychiatric treatment system that need to be changed to ensure proper treatment for PMUD with comorbid mental health problems.
Purpose - The purpose of this paper is to analyse 20 individual addiction recovery stories to find evidence for the G-CHIME model (Growth, Connectedness, Hope, Identity, Meaning in life and Empowerment) for analysing addiction recovery. It also shows that addiction recovery is a unique process. Design/methodology/approach - This research combines the findings from 20 individual addiction recovery stories, each having been reported separately using the same methodology for the purpose of publication in a book, or as part of a journal series. Patterns seen across the disparate narratives have been codified against the components in the G-CHIME model to produce a larger gestalt of the aggregated findings. Findings - Whilst each of the addiction recovery stories is unique, collectively they illustrate that recovery is a process which can be understood through the components of the G-CHIME model. Originality/value - To the best of the authors' knowledge, this is the first paper to analyse the G-CHIME model by extracting the common features of the model from 20 addiction recovery stories.
Purpose-The purpose of this paper is to examine recovery through lived experience. It is part of a series that explores candid accounts of addiction and recovery to identify important components in the recovery process. Design/methodology/approach-The G-CHIME model comprises six elements important to addiction recovery (growth, connectedness, hope, identity, meaning in life and empowerment). It provides a standard against which to consider addiction recovery. It has been used in this series, as well as in the design of interventions that improve wellbeing and strengthen recovery. In this paper, a first-hand account is presented, followed by a semi-structured e-interview with the author of the account. Narrative analysis is used to explore the account and interview through the G-CHIME model. Findings This paper-shows that addiction recovery is a remarkable process that can be effectively explained using the G-CHIME model. The significance of each component in the model is apparent from the account and e-interview presented. Originality/value-Each account of recovery in this series is unique, and as yet, untold.
