Dual diagnosis discourse, concerning people who are diagnosed with both mental health and substance use problems, has attracted little critical analysis. This article aids reflection on its implications for alcohol and other drug (AOD) treatment services. Qualitative analysis of 19 interviews with a purposive sample of service providers and public servants was validated with informants. Three contrasting narratives emerged—progressive (dual diagnosis discourse has lifted the sector to a level where services can better respond to complex needs in general); remedial (it has simply helped to improve the workforce's expertise in AOD treatment and “catch up”with mental health services); and radical (by patching a fragmented system it has dampened demands for major system reform). The diversity of views supports an argument for a metanarrative which, combining the strengths of the three narratives, continues to pioneer, to educate and, crucially, is explicitly conceptualized as part of a broader picture of well-resourced structural reform.
American Psychiatric Association. (2010). Diagnostic and statistical manual of mental disorders (5th ed.). Retrieved February 25, 2010, from www.dsm5.org
2.
Australian Healthcare Associates. (2011). Evaluation of the Victorian Dual Diagnosis Initiative. Melbourne: Author.
3.
Australian Institute of Primary Care. (2009). Comorbidity Treatment Service Model Evaluation: Final report. Bundoora, Victoria: La Trobe University.
4.
Australian State and Territory Peak Alcohol and Other Drugs (AOD) NonGovernment Organisations. (2011). Outcomes from the National Improved Services Initiative Forum: A tale of two systems. Adelaide: Author.
5.
BerridgeV. (2000). The impact of qualitative research on policy-making: Setting the scene. Luxembourg: EMCDDA.
6.
CareyK. B. (1989). Emerging treatment guidelines for mentally ill chemical abusers. Hospital and Community Psychiatry, 40(4), 341–349.
7.
CareyK. B.PurnineD. M.MaistoS. A.CareyM. P., & SimonsJ. S. (2000). Treating substance abuse in the context of severe and persistent mental illness—Clinicians' perspectives. Journal of Substance Abuse Treatment, 19(2), 189–198.
8.
CoombesL., & WrattenA. (2007). The lived experience of community mental health nurses working with people who have dual diagnosis: A phenomenological study. Journal of Psychiatric and Mental Health Nursing, 14(4), 382–392.
9.
DeansC., & SoarR. (2005). Caring for clients with dual diagnosis in rural communities in Australia: The experience of mental health professionals. Journal of Psychiatric and Mental Health Nursing, 12(3), 268–274.
10.
Department of Health and Community Services. (1994). The framework for service delivery. Melbourne: Author.
11.
Department of Human Services. (1997). Victoria's Alcohol and Drug Treatment Services: The Framework for Service Delivery. Melbourne: Author.
12.
Department of Human Services. (2008). A new blueprint for alcohol and other drug treatment services 2009–2013. Melbourne: Author.
13.
Department of Human Services. (2009). Because mental health matters: Victorian mental health reform strategy 2009–2019. Melbourne: State of Victoria.
14.
DrakeR. E., & WallachM. A. (1989). Substance abuse among the chronic mentally ill. Hospital and Community Psychiatry, 40(10), 1041–1046.
15.
GeertzC. (1973). Thick description: Toward an interpretive theory of culture. In The interpretation of cultures: Selected essays (pp. 3–30). New York: Basic Books.
16.
GerrandV. (2005). Transforming mental health services from 1993 to 1998 in Victoria Australia: A case study of policy implementation. Unpublished doctoral dissertation, University of Melbourne, Victoria, Australia.
17.
GlaserF. B. (1993). The concept of dual diagnosis: Some critical comments. In RileyD. (Ed.), Dual disorders: Alcoholism, drug dependence and mental health (pp. 49–59). Ottawa: Canadian Centre on Substance Abuse.
18.
KavanaghD. J.GreenawayL.JennerL.SaundersJ. B.WhiteA.SorbanJ. (2000). Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders. Australian and New Zealand Journal of Psychiatry, 34(2), 279–289.
19.
LubmanD. I.HidesL., & ElkinsK. (2009). Dual diagnosis: An issue of dual disorders or a dual system? In MooreD. & DietzeP. (Eds.), Drugs and public health: Australian perspectives on policy and practice (pp. 127–138). South Melbourne, Victoria: Oxford University Press.
20.
MeadowsG.SinghB., & GriggM. (Eds.). (2007). Mental health in Australia: Collaborative community practice. South Melbourne, Victoria: Oxford University Press.
21.
MericleA. A.AlvidrezJ., & HavassyB. E. (2007). Mental health provider perspectives on co-occurring substance use among severely mentally ill clients. Journal of Psychoactive Drugs, 39(2), 173–181.
22.
MinkoffK. (1989). An integrated treatment model for dual diagnosis of psychosis and addiction. Hospital and Community Psychiatry, 40(10), 1031–1036.
23.
MishlerE. G. (2005). Patient stories, narratives of resistance and the ethics of humane care: A la recherche du temps perdu. Health, 9(4), 431–451.
24.
MorganV. A.WaterreusA.JablenskyA.MacKinnonA.McGrathJ.CarrV. (2011). People living with psychotic illness 2010. Report on the second Australian national survey. Canberra: Commonwealth of Australia.
25.
PattonM. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Thousand Oaks, CA: Sage.
26.
PhillipsN., & HardyC. (2002). Discourse analysis: Investigating processes of social construction (Vol. 50). Thousand Oaks, CA: Sage.
27.
RiessmanC. K. (1993). Narrative analysis. Newbury Park, C.A.: Sage.
28.
RobertsB. (2012). Interprofessional relationships in dual diagnosis discourse in an Australian State: Are we respecting each other yet?Mental Health and Substance Use, 5(2), 148–159.
29.
RoeE. (1994). Narrative policy analysis: Theory and practice. Durham, North Carolina: Duke University Press.
30.
RoomR. (1998). The co-occurrence of mental disorders and addictions: Evidence on epidemiology, utilization and treatment outcomes [ARF Research Document Series No.141]. Toronto: Addiction Research Foundation.
31.
RosedaleM. T., & StraussS. M. (2010). How persons with chronic hepatitis C in residential substance abuse treatment programs think about depression and interferon therapy. Journal of the American Psychiatric Nurses Association, 16(6), 350–356.
32.
RussellS. (2009). Looking beyond dual diagnosis: Young people speak out. Melbourne: Research Matters.
33.
StaigerP. K.LongC., & BakerA. (2010). Health service systems and comorbidity: Stepping up to the mark. Mental Health and Substance Use, 3(2), 148–161.
34.
TalmetJ.De CrespignyC.CusackL., & AthanasosP. (2009). “Turning a blind eye”: Denying people their right to treatment for acute alcohol, drug and mental health conditions—An act of discrimination. Mental Health and Substance Use, 2(3), 247–254.
35.
TeessonM., & BurnsL. (2001). National Comorbidity Project. Canberra: Commonwealth Department of Health and Aged Care.
36.
TeessonM.SladeT., & MillsK. (2009). Comorbidity in Australia: Findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 43(7), 606–614.
37.
TorreyW. C.TepperM., & GreenwoldJ. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161.
38.
Victorian Auditor-General. (2011). Managing drug and alcohol prevention and treatment services. Melbourne: State of Victoria.
39.
WebbD. (2009). Consumer perspectives. In PhillipsP.McKeownO. & SandfordT. (Eds.), Dual diagnosis practice in context. Chichester: Wiley-Blackwell.
40.
World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research. Geneva: World Health Organization.
