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Individuals diagnosed with severe mental illness have higher rates of alcohol and substance misuse than the general population. This can present the client and the care team with a variety of issues around physical and psychological well‐being, as well as social and occupational functioning. In forensic psychiatry, the effect of comorbid substance misuse on offending behaviour is particularly pertinent. There have, however, been few studies examining the treatment of alcohol and substance misuse within this particular patient group.At a regional secure unit in North Wales, a group for inpatients was set up to provide education on alcohol and substance misuse over a course of six informal meetings, and to then evaluate participants' attitudes towards substance misuse. Of the six participants, five reported that their knowledge of substances had increased, and that they had no intention to use drugs again after discharge. Staff and client participants also suggested useful future topics for the group.

Although substance misuse by adolescents is widespread, few previous studies have investigated illicit drug use in adolescent psychiatric populations. The literature on adolescent substance misuse has focused on risk factors, and protective factors have received little or no attention. The study examined substance misuse and its correlates among young people referred to a regional adolescent psychiatric service. Co‐morbidity of substance misuse and psychiatric disorder was discussed, and the possible role of substance misuse as a gateway to adolescent offending examined. Recommendations for the development of adolescent substance misuse services are made.

The purpose of this paper is to provide a narrative review of the literature on substance use/misuse within an intellectual disability (ID) population. The paper is focused on the prevalence, motivation and implications of substance use as well as the interventions for misuse.

Research focused on substance use and ID (IQ of 70 or less with onset in the developmental period) were considered.

The findings indicate a disparity between research findings regarding the prevalence of substance use/misuse within ID populations. Previous research indicates that individuals with ID may use/misuse substances as a form of relief or respite from negative experiences. Although there is a clear need for intervention, many of the ID population do not engage with generic interventions for substance misuse. Additionally, professionals responsible for the provision of interventions identify a lack of training and support to meet the needs of ID populations.

Minimal research in this areas, barriers to language and demographics being underreported.

Highlights problems with the current evidence base and barriers this poses indicates a need for further research and intervention.

Implications for the equality for individuals with an ID and their access to appropriate intervention. Focus on prevention of offending behaviour and intervention as appose to management.

In order to build a greater understanding of this issue, a shared universal language and definition of ID must be implemented. Further research to improve the understanding of why those with ID misuse substances is imperative before designing and implementing useful interventions.

The purpose of this paper is to review the following research questions from the available literature: What evidence is there to suggest that substance misuse specifically by fathers (including alcohol and other drugs) causes wider harms, including child welfare concerns? substance misuse, recovery, parents, fathers, fathering, drugs/ alcohol services. How do professionals respond specifically to substance misuse by fathers? Do interventions aimed at parental substance misuse (particularly in the UK) include both mothers and fathers and if so how?

A scoping literature review was conducted which identified 34 papers (including scoping reviews published in 2006 and 2008, covering the period 1990-2005) and 26 additional studies published between 2002 and 2020.

The review in this paper is organised into six themes: Negative impact of men’s substance misuse problems on their parenting behaviours; quality of the relationship between parents affected by substance misuse of the fathers, in turn affecting the parenting behaviour and outcomes for children; importance to fathers of their fathering role (for example, as a financial provider); difficulties fathers may face in developing their fathering role; sidelining of the fathering role in substance misuse services; and professionals tending to focus on the mother’s role in parenting inventions and services.

This paper focusses on fathers and substance misuse, which is an under-researched field within the wider contexts of fathering research and research into parental substance misuse.

This paper considers parents who misuse substances. The potential impacts of their substance misuse on their ability to parent effectively and safely (parenting capacity) are explored, as are some of the barriers many parents face when attempting to seek treatment for problematic substance misuse. The terms ‘use’ and ‘misuse’ are used interchangeably in this paper and ‘substances’ refers to alcohol, illicit drugs and overuse of prescribed medicines. It is important to make the distinction between parents whose use of substances does not constitute dependency and might be best described as ‘recreational or hazardous’. Such individuals might not seek treatment and estimates of prevalence rates of use among this cohort are difficult as they remain hidden from services. Parents who might already be in treatment services or who might be seeking treatment might be described as ‘problematic or dependent’ although presentation at services is neither necessary nor sufficient to assume that the individual's misuse of substances is problematic or indicative of a dependency. The use of substances is associated with numerous harms to the individual: psychologically, socially, interpersonally and physically, and is a risk factor towards negative parenting practices. The use of substances in itself is not an indication of neglectful or harmful parenting, as many parents who use substances have adequate parenting skills, however, it is more frequently associated as a risk rather than a protective factor when considering potential harms. Most of the research refers to mothers although we are aware that some fathers may have sole parenting responsibility for their children. Parents, in particular mothers, face many barriers when trying to access substance misuse treatment services. When they are in treatment, services often lack the skills and experiences to be able to balance managing child protection issues and engaging the parent in treatment. A full review of the issues associated with parenting and substance misuse is beyond the scope of this paper and the reader is referred to Fowler (2003), Cleaver et al (1999), Velleman and Templeton (2007) and Day and George (2005) and the British Psychological Society's Child Protection Portfolio (2007) for further discussion.

Rates of co-morbid substance misuse are high within forensic populations. Addressing these problems should be a priority as mental disorder with co-morbid substance misuse is associated with worse outcomes, including rates of re-offending and violence recidivism. A study undertaken in 2006 by the Royal College of Psychiatrists’ Research and Training Unit concluded that the provision of substance misuse treatments in medium-secure units (MSUs) at that time was inadequate. The purpose of this paper is to investigate how services may have developed since then to inform discussion over future development and best practice.

A postal survey, supported by the Quality Network for Forensic Mental Health Services, was sent to 62 MSUs across the UK and Ireland. This questioned prevalence, interventions and staff training in substance misuse.

In total, 41 units responded (66 per cent). The data suggest rates of substance misuse within MSUs have reduced and provision of treatment has increased in recent years. The majority of MSUs provide a variety of interventions to address substance misuse and are internally resourced, in tune with current national guidance. However, the data suggest many MSU staff are not receiving adequate training in substance misuse treatments and some MSUs do not appear to have a cohesive strategy that would be consistent with best practice.

This study provides an up-to-date overview of the provision of treatment for substance misuse within MSUs.

There is no other source for this information, which will provide an invaluable reference point for services seeking to develop or improve their clinical services.

This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs.

The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients.

The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed.

The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs.

This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes.

This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

This paper offers readers a review of the literature on alcohol and illicit drug misuse in people with learning disabilities, focusing on six key areas. First, clarity is provided on the definition of ‘misuse’. Second, prevalence rates are examined along with the methodological difficulties involved in such studies, the authors arguing that prevalence rates are higher than current estimates. Third, the authors explore the relationship between the intra‐ and inter‐personal risk factors. Fourth, the nature of the substance misuse is explored, with a focus on offending behaviour. Fifth, a range of treatment modalities are described with a series of recommendations for more robust evidence‐based interventions. Last, the authors explore the gaps in policy that lead to a dearth in service provision as well the barriers which people with learning disabilities face on entering treatment services. The paper cites four innovative projects that address this population's needs in England, and illustrates how Northern Ireland has positioned the needs of this hidden population within the Department of Health, Social Services and Public Safety (Northern Ireland).

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.

Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.

Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.

This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.

Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.

Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

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.

This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings.

In clinical practice, shared treatment has proved challenging in light of different service models (Laker, 2006). Substance misuse works on the premise of change comes from the individual, where recovery models in mental health offer a formalised approach. One of the challenges faced by services has been the inability for mental health services to recruit and services become overstretched (Rimmer, 2018); this gave an opportunity for a new method of working to be considered. This led to the development of a new service model.

These changes were:

• Improving the interface with substance misuse services to improve access to community substance misuse services for mental health clients.

• To provide specialist staff within the dual diagnosis field to provide a clinic jointly with local drug and alcohol services.

• Introduction of substance misuse workers as team members on acute mental health and rehab wards.

• Group Substance Misuse programmes.

Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group.The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge.For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances.

Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups.

The purpose of this paper is to understand service users’ experience of a new acceptance and commitment therapy (ACT)-based substance misuse programme. The programme is designed for people in secure mental health services, presenting with complex mental health difficulties and co-occurring substance misuse problems.

A qualitative approach informed an exploratory pilot of this novel intervention. Service users completing a 16-week ACT programme were invited to participate in the current study. Out of the nine individuals enroled on the programme, six opted to take part in the exploratory pilot and completed semi-structured interviews following part 1 of the programme (eight weeks). Four of these participants proceeded into part 2 of the programme (eight weeks) and completed a further semi-structured interview.

The thematic analysis identified five main themes: “Increased awareness of personal values and the impact of substance use on values”, “Taking committed action towards values”, “Coping skills and the application of skills to manage difficult thoughts and feelings”, “Personal development” and “Use of metaphors/analogies”.

A quantitative evaluation of clinical outcomes is recommended to gauge further programme effectiveness.

The findings provide preliminary support for the use of an ACT-based substance misuse programme in a secure mental health setting.

This study evaluates the use of a novel ACT-based substance misuse intervention with people in secure mental health care with co-occurring mental health and substance misuse difficulties. This paper provides an in-depth understanding of service users’ experience of participating in this new treatment programme.

This paper aims to describe: the need for substance misuse treatment with high risk, personality disordered prisoners, and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options.

In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and ‘InsideOut’ interventions are presented. These interventions adopt a risk reduction and health intervention approach respectively. This includes explanations of how they came to be implemented within a prison based personality disorder treatment service and potential ways to evaluate these services.

Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery.

The high levels of co-morbidity between personality disorder and substance misuse disorders in the high security prison estate highlights the need for substance related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered.

This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

As the use of drugs and alcohol by clients accessing mental health services becomes increasingly common, members of staff working within psychiatric inpatient areas often encounter drug and alcohol misuse among their client group. The safe and effective management of this issue has become a priority for many inpatient services. This paper outlines a policy for the management of substance misuse on psychiatric inpatient wards developed by Manchester Mental Health and Social Care Trust. The fundamental principles underpinning the policy are highlighted, and the key sections of the policy are described. There is a detailed description of how the policy has been applied in practice by members of staff working on inpatient wards, with clinical examples being presented.

The purpose of this paper is to determine whether the diagnosis of both carers’ mental health problems and substance misuse increase the likelihood of recurrent child maltreatment over and above the individual effects of these factors.

Retrospective secondary data analysis of 29,455 children where child maltreatment was confirmed in the Victorian child protection system between 2001 and 2005. Recorded mental health, alcohol misuse and other drug misuse variables were entered into multivariate logistic regression models predicting repeated child maltreatment. Interactions and a range of other child, carer and socio-economic factors were included in these models.

Carer alcohol misuse, other drug misuse and mental ill health all independently predicted recurrent child maltreatment. The presence of both other drug misuse and mental ill health increased the likelihood that recurrent child abuse was recorded over the likelihood that mental health alone predicted recurrent child maltreatment, and while alcohol misuse had an effect when there was no mental health condition recorded it did not have an additional effect when there was evidence of mental health problems.

Children in families where there is both mental health problems and other drug use problems are at greater risk of repeated maltreatment than where there is evidence of mental health problems or other drug use alone. Where there was evidence of carer mental health problems, alcohol misuse did not add to this likelihood. However, the effect of mental health and other drug use was similar in size to the effect of alcohol misuse alone.

These findings add to understandings of the effects of co-occurring mental health problems and substance misuse on recurrent child maltreatment and differentiate between cases that involve alcohol and other drug misuse.

Despite Policy Statements and abundant evidence of the particular needs and problems of those with a dual diagnosis of mental health problems and substance misuse, very little that is effective is being done for this group. The paper reviews the evidence and considers some of the solutions proposed.

Few studies have examined coparenting characteristics and experiences of fathers who use substances and are aggressive with their partners. The purpose of this paper is to use quantitative and qualitative measures to increase knowledge of coparenting of fathers with co-occurring substance use disorders and histories of intimate partner violence (IPV) to inform intervention efforts with this population.

Baseline interviews were used from 62 fathers in a residential treatment center who participated in a longitudinal research study about interventions for substance-misusing fathers. Coparenting-related themes were identified through qualitatively analyzing transcripts of fathers’ responses to the Articulated Thoughts in Simulated Situations (ATSS) task. Fathers completed the Coparenting Relationship Scale (CRS), Conflict Tactics Scale Revised and the Child Trauma Questionnaire. Correlations were examined to determine if themes generated from the ATSS task were associated with IPV severity or coparenting relationship.

Qualitative analysis of transcripts revealed six themes: hostility, dismissiveness, non-confrontational, child-focused, feeling undermined and being active or non-active in the ATSS task. Qualitative themes were not significantly correlated with self-reported coparenting on the CRS except coded dismissive responses were positively associated with self-reported undermining by their coparent. Self-reported physical and psychological aggression were significantly positively associated with self-reported coparent undermining but were not significantly associated with qualitative themes.

This study is the first to use qualitative analysis of responses to coparenting situations to understand ways fathers in substance misuse treatment with histories of IPV think about coparenting to guide interventions.

There have been few studies about the prevalence of substance abuse and links to offending behaviour among those with intellectual disabilities. This paper aims to address this issue.

This baseline audit describes: the prevalence of alcohol and substance misuse in patients within a forensic intellectual disability service; and the introduction of a Drug and Alcohol Awareness Course. In total, 74 patients were included in the audit.

Roughly half of the patients audited had co‐morbid harmful use or dependence with the problem being equally prevalent in men and women. Whilst alcohol and cannabis were the commonest drugs of abuse, cocaine, stimulants and opiates were abused by a small but significant number. Of those with harmful use or dependence, 35 per cent had used the drug in the immediate lead up to their index offence. A diagnosis of personality disorder and past history of convictions for violent offences was significantly more likely to be present in the group with harmful use or dependence. There were no differences on major mental illnesses or pervasive developmental disorders.

The high prevalence of substance abuse makes it an important risk factor that could determine treatment outcomes. Forensic intellectual disability units need replicable substance abuse targeted treatment programmes that can be formally audited and evaluated.

Findings are discussed in relation to service planning and treatment outcomes from forensic intellectual disability services.

The purpose of this paper is to examine the role of co-parenting, childhood experiences, and satisfaction with fathering in a sample of men in a long-term residential drug rehabilitation program.

A paper and pencil survey was completed by 128 men between the ages of 18 and 68 (M age=30.42 years) in a court ordered residential rehabilitation center for drug misuse. Of the 128 respondents, 40.625 percent (n=52) were fathers and completed a longer survey to assess their co-parenting relationships.

The percentage of men with positive role models did not differ between the fathers and non-fathers, with 40.4 percent of fathers having had a positive role model growing up, χ²(1, n=127)=0.54, p=0.816. Fathers were more likely to report witnessing IPV between their parents during childhood than non-fathers, χ²(1, n=125)=4.7888, p=0.029. Linear regression models examining factors associated with co-parenting agreement and exposure to conflict were significant, but witnessing IPV as a child was the only significant individual predictor.

Exposure to IPV in childhood was a common experience for fathers in residential treatment for substance misuse. Fathers reported significant problems in their co-parenting relationships indicating a need for fatherhood and co-parenting focused services available within residential treatment programs.

There is little research about fathers with co-occurring histories of substance misuse and IPV in residential treatment. This paper is the first to examine co-parenting in this specific population.

Dual diagnosis (DD) has become a challenging therapeutic issue of our time. As a substance misuse practitioner, I, like many of my colleagues have often been frustrated with the difficulties that service users face in trying to address their issues, often being bounced between services that are unable to meet their needs. This article looks at some of the challenges that face staff working in both substance misuse services and mental health services as they work to deliver services to a group of service users with multiple and complex needs. It will look at the way in which we define dual diagnosis, the challenges that face both services and service users, how new government guidance could impact upon improved working practice and outcomes in the future and what some of the barriers are to the successful implementation of this guidance.

Housing and support are essential if people misusing drugs and alcohol are to address their substance misuse and their other physical, mental and emotional health needs. If their housing and related support needs are not addressed at each stage of the treatment journey, they are much less likely to enter or remain in treatment. This article outlines the policy context, discusses barriers in service development, explores the role of housing with support for substance users and gives examples of imaginative commissioning and provision. It is based on recent work for the Department of Health Care Services Improvement Partnership.

Many ex-offenders and substance misusers are employed in the treatment and intervention of offenders. The purpose of this paper is to investigate this role as a protective factor in the maintenance of desistance.

Seven paraprofessional employees of a substance misuse service were interviewed using semi-structured interview and analysed by Interpretative Phenomenological Analysis.

Four super-ordinate themes emerged: “The Fragile Sense of Self”; “Hitting Rock Bottom”; “Belonging and identity” and “Maintaining the role reversal”. These themes captured the journey of moving through crime and substance misuse into desistance and employment.

The sample size is small; therefore generalisation is reduced. Using Interpretative Phenomenological Analysis (IPA) could be considered subjective. Further research should attempt to explore similar ideas with different populations and using different methods.

This work suggests that practitioners and policy makers should look at the vital importance of paraprofessional employment in relation to desistance from crime.

Offenders and substance misusers are often left without direction or a fixed new identity, and return to the only life they have known. This study suggests that paraprofessional employment might provide a sense of belonging and identity that could benefit the ex-offender, their clients and society.

This is an opportunity to advance knowledge in the area of paraprofessional employment as an aid to “recovery” and lifelong desistance.

An association between problematic substance use and severe mental illness has been demonstrated in various settings, but not among community forensic psychiatric patients. This paper aims to investigate the prevalence and correlates of problematic substance use among the community patients of one regional forensic psychiatric service.

Historical data on diagnosis, offending and problematic substance use were gathered by reviewing case notes. Current substance use and psychosocial functioning were ascertained from structured interviews with community psychiatric nurses. Outcome measures included HoNOS ratings, the Global Assessment of Functioning, and the Clinical Rating Scale for substance use.

Of 92 patients, 91.2 per cent had a history of problematic substance use and 31.5 per cent of them were currently using substances problematically, most commonly cannabis and alcohol. Current problematic substance use was associated with a range of negative outcomes, in terms of illness severity, compliance with treatment, and psychosocial functioning.

The results may not be generalizable to services in different areas or those with different models of service provision. Causality should not be assumed from a cross sectional study.

Inpatient psychiatric treatment in secure services appears to be associated with a large reduction in the level of problematic substance use, but a large residual need remains among community patients. Services which provide community care for forensic patients must seek to integrate treatment for problematic substance use with treatment for mental illness.

This is the first description of the substance use related needs among community forensic psychiatric patients.

Substance abuse and dependence to alcohol, tobacco and other drugs (ATOD) is a universal public health problem extending across all borders, and including all ethnic, cultural, religious and socioeconomic boundaries. It is a condition that the nursing profession worldwide struggles to better understan. At the global level, differences in beliefs and practices regarding ATOD have resulted in a wide variation of how these problems are handled and treated.Examining and comparing those between the US and the UK can illustate an example of the differences in addictions nursing practice. Underlying assumptions of the current alcohol and drug policies in the US have been mainly based on prohibition, criminalisation and a drug‐free society ideology (Nadelmann, 1997) while the UK policies have been based on the belief of ‘harm reduction’ (Coyne & Clancy, 1996). This paper discusses some of the historical, philosophical and cultural differences between the US and the UK that have led to the respective differences in societal attitudes and treatment practices for substance abuse or ‘substance misuse’ within these two separate societies.

It is dangerous in relation to practice and safeguarding to conclude that risks exist, or do not exist, in relation to a particular type of parental behaviour and family functioning. Using parental alcohol use as an illustrative topic this chapter explores definitions of alcohol use, the significance of parental use and the mechanisms and ways it is believed alcohol use leads to harms and then affects children and their educational experiences. In doing so this chapter recognises that it can be challenging and difficult to identify different thresholds of harms and risk from parental substance use alone. It also recognises and concludes by critically reflecting on the role teachers and educational staff have to play in assessing need, reducing pupil and parental stigma and shame around alcohol use, understanding the position of the parent and what children need to encourage their involvement and discussion around concerns like parental alcohol use.

The purpose of this paper is to examine the extent to which the two visions of recovery that are now being developed in the UK are consistent with each other and question what impact the development of parallel approaches will have on people at the intersections between them.

The paper looks first at the origins and current implementation of the two approaches and then examines the commonalities and differences in the context of what they might mean for people using both sets of services simultaneously.

The ideas behind Recovery in mental health and substance misuse services have some differences but significant common ground in focusing on improving quality of life.

This paper points to the need to understand recovery in both services from the perspectives of those who have a dual diagnosis and need support from each service.

This paper could be used to develop new approaches to supporting people with a dual diagnosis with a consistent Recovery focus.

Placing personal recovery at the heart of both mental health and substance misuse services may, over time, improve their efficiency and effectiveness.

To address safety risks, worker well-being concerns and productivity losses in construction due to substance misuse, this study aims to explore awareness and usage levels of various substances among Nigerian construction professionals. The findings aim to inform targeted interventions and policy development to tackle these industry-specific challenges.

A comprehensive literature review identified several substances and intoxicants commonly used in construction, which informed the development of a well-structured questionnaire. This questionnaire was distributed to both construction professionals and nonprofessionals. The Shapiro-Wilk test assessed the normality of awareness and utilization scores for each substance, while the Kruskal-Wallis H-test explored significant differences in awareness and usage scores among different respondent groups.

Despite reporting low awareness of substances commonly used in construction, a significant proportion (over 60%) of respondents admitted to using several of these substances in their construction activities. This highlights a concerning disconnect, with more than half (62.5%) exceeding a predefined threshold (3.5) for significant substance use. Ten out of the 16 substances surveyed fell into this category, indicating a widespread issue within the industry.

The findings of this study highlight the need for increased education and awareness programs about the dangers of substance misuse in the construction industry. Construction companies should implement regular training sessions and workshops to educate workers on the risks associated with substance use. Additionally, there should be stricter enforcement of substance use policies and routine substance testing to deter misuse. These measures can enhance safety, improve worker well-being and boost overall productivity in the construction industry.

The insights from this study can inform the development of international policies and best practices for substance use prevention and worker well-being in the construction industry. Sharing these findings with international organizations, policymakers and industry stakeholders can help create broader guidelines and frameworks adaptable for implementation in various countries.

Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey.

Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis.

Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”.

The research excluded people who recover outside of services, replicating a shortcoming of much research in this area.

The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working.

The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population.

A substance misuse curriculum was developed using a creative approach. Key players identified were: a community outreach worker, a nurse consultant, a communication expert and an academic. Communication was seen as a fundamental and integral cornerstone of practice and played a major role in the curriculum. The increased awareness of coexisting morbidity was also seen as a growing and relevant issue. Practitioners were involved and played a pivotal role in this development. The role of the academic was to facilitate the process and ensure that the curriculum was evidence‐based, creative and utilised the philosophy of problem‐based learning.

The purpose of this paper is to investigate Keyes’ (2007) model of mental health, the presence (flourishing) or absence (languishing) of social, emotional and psychological wellbeing, in the context of drug and alcohol misuse and the frequency and pattern of community participation (engaging in society).

Participants were 1,815 individuals (70 per cent male) who entered residential substance misuse treatment provided by The Salvation Army. Questionnaires were completed at intake assessments with The Salvation Army staff. The data were compared with population norms of community participation utilising t-tests, while multiple linear regression was used to examine continuous mental health.

Although participants have lower levels of community participation compared to Australian population norms, those participants who were experiencing flourishing mental health had higher rates of community participation than Australian norms. Keeping in touch with friends and family was the most common form of participation. Informal social connectedness and civic engagement were the strongest predictors of mental health over and above more traditional substance use outcomes such as cravings.

This is one of the first studies to describe the relationships between community participation, substance use and mental health in participants seeking treatment for substance misuse. Despite having a drug or alcohol addiction requiring treatment, those participants with flourishing mental health have higher levels of community participation than community norms. Furthermore, community participation predicts mental health. This offers promise for interventions that increase community participation but further research using longitudinal designs is needed to replicate and clarify the direction of these relationships.

Substance misuse (SMU) is widely prevalent in mentally disordered offenders and is linked with violence and offending behaviour. There is however, a scarcity of literature dedicated to investigating SMU and its clinical correlates in relation to patients detained within high secure hospital settings. The purpose of this paper is to investigate the extent and severity of SMU and corresponding treatment needs in patients with a primary diagnosis of personality disorder (PD) in comparison with mental illness (MI) in a high secure hospital.

The responsible clinicians of all patients (n=240) detained in a high secure hospital were asked to record information using a SMU screening questionnaire over a ten-month period. Details requested included substance type, history of past use and assessment and treatment needs. Data were recorded and then analysed: descriptive statistics were conducted to report historical use of substances, cross tabulations and χ² analysis explored the relationship between SMU and treatment status and diagnosis and offending behaviour and a means comparison analysis was employed to explore length of stay and treatment of SMU.

A total of 230 questionnaires were returned (95 per cent of the patient population). A history of SMU was reported in 88.6 per cent of the sample, with alcohol and cannabis misuse being the most prevalent. At least one substance had been abused by 74.3 per cent of the sample. In two-thirds of the sample, SMU was linked with the onset of mental health problems and symptom exacerbation, including violence. Interestingly, patients with a diagnosis of MI as compared with PD were more likely to have used substances (93.3 per cent compared to 81.9 per cent) and were more likely to need treatment for SMU (64.3 per cent compared to 36.8 per cent). In those with an MI diagnosis, SMU was more likely to be linked with violence and index offence (74.3 per cent compared to 59.0 per cent).

SMU is significantly prevalent in high risk mentally disordered offenders and linked to onset of mental health problems and offending. Patients with schizophrenia have a higher prevalence of SMU than PD and are likely to be more in need of treatment. Violence and offending are more likely to be related to SMU in schizophrenia than in PD.

This study substantiates existing evidence that SMU contributes to mental health problems and criminogenic behaviour. Furthermore, the study reports new findings that characterize differences of the relationship of SMU to offending in schizophrenia and PD in forensic psychiatric patients presenting to a high secure hospital.

The existing evidence base and policy context of sports‐based prisoner health promotion is evaluated, and an original analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales is presented, with a focus on the variability of provision across different prison establishments.

Inspectorate reports published by Her Majesty's Inspectorate of Prisons (n=184) were analysed to assess the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. Examples of innovative sport‐based health promoting programmes are drawn upon in order to illustrate principles of best practice.

Despite health promotion being engrained in existing policy, the degree to which physical, mental health and substance misuse needs are addressed through sport in prison remains highly variable and locally contingent across the secure estate, although examples of innovative practice are evident.

For sport to promote prisoner health most effectively, tailored sports provision should be embedded within multi‐modal interventions which draw on internal and external partnerships and promote opportunities for ongoing sporting participation. Further research is required to delineate principles of best practice applicable to discrete prisoner populations.

Sport can play a key role in addressing a multitude of prisoner health needs whilst contributing to achieving “healthy prison” objectives in practice. Sport and physical activity clearly offers a valuable way of motivating prisoners to engage in health promoting initiatives.

The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.

This paper will review the estimated prevalence of ‘dual diagnosis’ among young offenders, briefly review the gaps in service and look at what research tells us about what works best with young people. The group this paper focuses on in the main are those 18 years of age and under and who have come into contact with the criminal justice system and have dual diagnosis. At times, however, the authors draw from a wider literature because working with young dual‐diagnosed offenders is a relatively new field.

Substance use tends to be overlooked in nursing training. As a possible consequence, many nurses harbour ill‐informed or even negative attitudes towards drug and alcohol users. The upshot can be poor care. In a bid to tackle this problem, a group of students developed a peer‐led workshop by encouraging open debate on issues associated with illicit drug use and access to healthcare for those with substance misuse problems. What ensued was an open and frank debate that increased awareness and the thirst for more knowledge.

Alcohol misuse and mental health problems in parents are both known to contribute to impaired outcomes in children, although little is known about the specific parenting behaviours that might be affected. Mental health problems in parents who misuse alcohol may impact parenting in specific ways, and these may be different for mothers and for fathers. The purpose of this paper is to make a preliminary investigation of alcohol misuse and mental health problems in mothers, and explore ways in which these might affect their parenting.

Semi-structured interviews were carried out with professionals involved in services for mothers who misuse alcohol, including those working in addiction psychiatry, in primary care, and in the provision of parenting services. These interviews were then examined using thematic analysis.

Themes emerged including specific mental health problems (depression, anxiety and personality disorders), and related issues, such as self-medication. Particularly relevant for mothers were post-natal depression, the effect on maternal alcohol misuse and mental health when children are removed, the role of domestic violence, and the importance for identification of home visits by services. Different types of alcohol misuse were linked to different mental states and different parenting behaviours in parents. Findings in the general parenting and substance misuse literature were confirmed, and a new addition was that expressed emotion may play a role in families where mothers misuse alcohol.

The findings increased the understanding of the relationships between maternal alcohol misuse, mental health issues and parenting, raising several new points for consideration.

Little research has been carried out on the links between drug misuse and domestic violence. This article attempts to address this gap by presenting key findings and recommendations from research carried out by Perpetuity Research and Consultancy International Ltd in the West Midlands exploring the links between substance misuse and domestic violence

The purpose of this paper is to critically regard the concept of recovery from the perspective of substance misusing offenders. It intended to understand how these individuals came to define recovery by asking “what does recovery mean to you?”

In total, 35 semi-structured interviews were undertaken with individuals with a history of heroin and crack cocaine use as well as convictions for a range of offences. Interviews took place in both prison and community settings, reflecting a spectrum of experience.

Whilst the constellation of recovery varied, it was at times made up of the same “stars” – and some re-occurring themes emerged; recovery was transient, fragile and unpredictable, it was ongoing, lacking a definitive end, it was more than abstinence and often involved a total psychological overhaul, recovery was about reintegrating with society and feeling “normal”.

Practitioners and services need to value the individual interpretations of recovery rather than being prescriptive around what it “should” look like. The components of recovery that were raised by participants permit specific recommendations for practice to be made.

This study sought the perspectives of those actually affected by and experiencing drug treatment in the Criminal Justice System. It allowed participants to tell their story without preconceived ideas or hypotheses, putting their voice at the centre of the stage. The study uses feedback from the ground to make informed recommendations for practice.

The purpose of this paper is to explore whether there are ways in which the preventive strategies used to tackle volatile substance abuse (VSA) can be usefully applied to today’s new psychoactive substances (NPS).

In 2010-2013, with funding from the Big Lottery, Re-Solv, in partnership with St George’s, University of London, and educari, commissioned a re-analysis of both the mortality data relating to VSA and of the legislative and preventative measures taken that may have played a part in the steady downward trend in VSA mortality since. This paper is informed by Re-Solv’s research findings and the papers resulting from it, namely, Ives (2013) and Butland et al. (2013).

Efforts to reduce the harm from NPS could benefit from a re-examination of preventive approaches to VSA, which have resulted in a downward trend in mortality over the past two decades.

There is evidence from past prevention practice which could be relevant and applied to present day concerns about drugs and substances not previously available or used.

This is the first paper to explore how learning from VSA might be applied to NPS and the “legal highs” of today.

This paper proposes a model for a dual diagnosis service within a male local prison. Dual diagnosis can be considered usual rather than exceptional within the establishment and indeed within the prison estate. For a variety of reasons, it is found that effective dual diagnosis service delivery represents core business for a range of stakeholders. The dual diagnosis definition preferred is ‘a mental disorder and substance misuse problem in the same person at the same time’. Analysis of the strengths of current service provision and the risks to the development of a new service model are explored through a strengths, weaknesses, opportunities and threats (SWOT) analysis. Current literature and policies inform the model, and it is concluded that a dual diagnosis service can be implemented mostly within existing resources. An implementation schedule highlights one such pathway. Stakeholders were consulted and generally found to be receptive.

The purpose of this paper is to illustrate the history of relevant legislation before and after the 1971 Misuse of Drugs Act (MDA).

A chronological narrative of laws and reports with concluding discussion.

That UK legislators have not made use of the evidence base available to them and have favoured enforcement rather than treatment approaches. That current UK practice has exacerbated not contain the use of and harms caused by illegal drugs.

The paper does not cover all relevant documents, especially those from non-governmental sources.

The practical implications centre on the failure of consecutive governments to reflect on and review the impact of current legislation, especially on people who use drugs.

That the situations of people who use drugs are currently ignored by the government and those proven responses which save lives and reduce harm are rejected.

The paper attempts to show the historical contexts of control and dangerousness of which the MDA is one instrument.

This paper explains the service model devised in one London borough to help and support people with dual diagnosis. As well as discussing management, decision‐making and training issues, the authors outline what works, what does not work and what other organisations can learn from their experiences.

This paper describes the efforts of an academic and practitioners to work together to improve the care of people with a dual diagnosis within one acute mental health care ward. The project was informed by a practitioner action research approach. The group sought to build alliances between academics and practitioners to address problems in practice. The paper focuses on the outcomes for the nurses and trainers, as well as considering its impact on overall care delivery.

Positive psychology is an area of rapid development in mainstream psychology, yet it has had little impact thus far in the field of dual diagnosis (DD). Effective treatment for clients with DD is limited, due to the lack of all-encompassing interventions that treat the two conditions simultaneously. The purpose of this paper is threefold: first, to discover the prevalence of DD among users of selected drug services in Manchester; second, to explore differences between DD clients and those with substance use in hope, resilience, and well-being; and third, to identify predictors of hope, resilience, and well-being in this population.

The Snyder Hope Scale, the Connor-Davidson Resilience Scale, and the Short Warwick-Edinburgh Mental Well-being Scale were administered to 113 users of drug services through a convenience sampling method.

Findings from this preliminary investigation indicated that the DD group were more vulnerable as they were less hopeful, less resilient, and had poorer well-being than their counterparts.

This population of clients might benefit from specialized integrated treatment facilitating hope and resilience, which in turn would improve their well-being.

The present study addresses a gap in the literature. Although the above positive psychological aspects have been looked at in relation to mental health, and in relation to addiction, the current research explores these positive dimensions with regard to the co-occurrence of substance abuse and mental illness.

The task of keeping Britain’s workplaces free from the risks associated with recreational drugs has been a long and challenging one for HR professionals and line managers.

Expertise and research carried out by Synergy Health Laboratory Services.

A no-tolerance approach to drug misuse within the workplace – even one enforced through random testing – should not be seen as draconian because, after all, the safety of colleagues, customers and others is as much at stake as the safety of the individual concerned or indeed the reputation of the company.

With properly drafted policies and robust processes, employers can safeguard themselves and their employees straight away from the risks posed by illicit substances.

The purpose of this paper is to summarise the findings from two projects in Northern Ireland which investigated the feasibility of adapting an existing adult intervention, the 5-Step Method, for children affected by parental substance misuse and/or parental mental illness. The structured brief psychosocial intervention is called Steps to Cope and can be delivered as an individual or group intervention.

The two projects recruited and trained 57 practitioners from across Northern Ireland, 20 of whom went on to use the Steps to Cope intervention with a total of 43 children.

It appears possible to adapt the intervention for children; to train practitioners, some of whom are able to use the intervention with one or more children; and for the intervention to benefit children in line with the five steps of the intervention targeting areas such as health, feelings, information, coping, support, and resilience. However, there are organisational and practical barriers to delivery which need to be overcome for the intervention to be more widely implemented.

Steps to Cope is a unique intervention for this population and the findings discussed here suggest that the model has potential in an area where support for children in their own right is lacking.