Highlighting comorbidities

As an Assistant Psychologist working within a drugs and alcohol service, I was excited to see a feature on alcohol in the July issue. However, I was rather disappointed by the lack of reference to dual diagnosis – comorbid mental health and problematic substance use. Although Kelleher highlighted anxiety and depression as often comorbid with alcohol misuse and Haydock briefly mentioned the 'messy issue' of dual diagnosis, the articles failed to address the high prevalence rates and impact of this.

Within the service where I work, we support clients with complex dual diagnoses and/or complex trauma every day. We recognise that substance use and mental health arrive, all too often, hand-in-hand. This fact is not highlighted enough. If people better understood that there are often deeper psychological reasons leading to alcohol or drug use and that the behaviour can be seen as a way to manage overwhelming thoughts and feelings then maybe there would be less self-stigma amongst those with problematic substance use and less stigmatisation by the wider society towards them.

Most clients I work with have been turned away by mental health services. Despite their distress, which can manifest as suicidal ideation, and despite their genuine mental health needs, services such as IAPT, CMHTs and even crisis teams routinely maintain that they cannot support clients who are potentially harming themselves through alcohol and drug use. The narrative that people cannot engage with (or benefit from) such support until they have addressed their alcohol and drug use problems, I would argue, is not our experience here or in the addiction psychology field.

I am lucky to work in a drugs and alcohol service which has an in-house psychology team that can support clients with dual-diagnosis. Practice-based evidence is teaching us that psychological interventions can and do alleviate the distress of people coming through with alcohol and/or substance issues and – in so doing – serve also to reduce and/or stop their use. However, there needs to be more mental health provision and fewer barriers within CMHTs for this population, especially as those with dual-diagnosis are some of the most vulnerable and marginalised people in our society. Services commissioned to address problematic alcohol and substance use cannot achieve this in isolation. Clients need compassionate, non-judgemental and effective mental health support and this is why dual-diagnosis must not become an aside in our communication about issues pertaining to alcohol and substances.

Ruby Ramsden MBPsS
Senior Assistant Psychologist
Northampton