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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.