To examine how non-pharmacological integrated treatment components are presented in the literature, to facilitate high-quality dual diagnosis treatment and support informed decision-making in the development of integrated treatment facilities. A literature search was conducted in databases Ovid/Embase, PubMed, CINAHL focusing on intervention studies published between 2013 and 2023, describing integrated treatment for patients with dual diagnosis. A six-stage methodological framework for scoping reviews was used for selection and analysis of the papers included. Twenty-six studies were included. Most integrated interventions were group therapy sessions guided by CBT or MI, however there was a large heterogeneity in the remaining core components and outcome measurements. Staff competence was often vaguely defined and described. : The heterogeneity of the studies included influences reproductivity and comparability which makes it challenging to condense firm recommendations and point directions for design of treatment and scientific practice.

Co-occurrence of schizophrenia/schizoaffective disorder (SSD) and stimulant use disorder (StUD) is an ongoing clinical problem and can lead to poor outcomes. Although emerging evidence has suggested psychostimulant substitution therapy may result in improved outcomes in those with StUD, the efficacy and safety of psychostimulant substitution therapy for StUD in those with concurrent SSD is uncertain. This review aims to systematically find and assess all available efficacy and safety evidence on the use of prescription psychostimulants in those with co-occurring SSD and StUD. Electronic searches of MEDLINE, PsycINFO, Embase, Scopus, ClinicalTrials, EU Clinical Trials, and CADTH were conducted from inception to February 27, 2024. Any study design was accepted if they involved the following concepts 1) SSD and StUD and 2) prescription psychostimulants. Given the paucity of trials meeting criteria, outcomes of interest were described qualitatively. Risk of bias was assessed using Q-Coh and ROB2. Only seven articles met criteria, and most of these were case reports and series. The single RCT included was at high risk of bias. Outcomes included abstinence, reductions in non-prescribed stimulant use, psychiatric hospitalizations, levels of craving, improvements in mental health, improvements in psychosocial functioning, adherence to antipsychotic medications, and retention in treatment. Most of the results indicated that psychostimulant substitution therapy in individuals with SSD-StUD was not associated with improved outcomes. Available evidence for treatment of StUD via psychostimulant substitution therapy in individuals with SSD is lacking. More exploration is required for this clinical question to allow for current practice to be backed by evidence.

Drug use and related harm among women of color who experience intimate partner violence (IPV) is a serious clinical concern. Depression symptoms have been identified as an important risk factor for the development of drug use and related harm among women of color with a history of IPV. The current study advances this research by examining the roles of distinct domains of racial microaggressions in the relation between depression symptoms and drug use and related harm in this population. Participants were 103 women of color experiencing IPV ( = 40.39, 51% Black/African American). Results indicated an indirect effect of depression symptoms on drug use and related harm via racial microaggression domains of Assumptions of Inferiority, Second-Class Citizen and Assumptions of Criminality, Microinvalidations, Exoticization and Assumptions of Similarity, and Environmental Microaggressions. Findings provide preliminary support for the role of racial microaggressions in the association between depression and drug use and related harm among women of color experiencing IPV.

This study examined behavioral health clinician perceptions at the beginning stages of the COVID-19 pandemic regarding their preparedness, training, and effectiveness in delivering telehealth to adults and adolescents in substance use and mental health settings. Data were collected through an anonymous online survey of 241 behavioral health practitioners in Pennsylvania from November 17, 2020, to January 3, 2021. Quantitative descriptive and qualitative analyses on survey results are presented. Clinicians believed they were effective in their delivery of therapeutic services through telehealth modalities. However, they noted key training needs for delivering telehealth. Results indicate greater difficulty in delivering telehealth to adolescent clients and those with substance use. Practitioners indicate that telehealth allows greater access to treatment. Researchers recommend increasing training for practitioners and conducting training for patients. Policies should be reconsidered and address the changing landscape of behavioral health service provision.

The relationship between concurrent depression and Opioid Use Disorder (OUD) treatment outcomes remains incompletely understood. Prior studies found mixed results regarding the impact of psychiatric comorbidities on retention to medications for OUD. This study aims to evaluate how the receipt of pharmacotherapy for depression impacts retention to buprenorphine therapy among patients with OUD and concurrent depression. We conducted a retrospective cohort study using the Humana Healthcare Research claims database (2014-2020) on a sample of adult patients who initiated buprenorphine for OUD between January 2015, and September 2019. Patients were required to have a 180-day buprenorphine-free period pre-index. Patients with concurrent depression were identified via diagnosis in a medical claim within the baseline period. Antidepressant use was defined as cumulative exposure from the start of the baseline through the end of the 180-day follow-up period. The primary outcome was time to buprenorphine discontinuation, defined as a gap of more than 30 days from the day of last supply. Cox Proportional Hazards regression was used to estimate the association between antidepressant receipt and buprenorphine discontinuation. Sensitivity analyses on specific classes of antidepressants were also conducted. The final analytical cohort included 1,973 patients with OUD and concurrent depression. Of these, 235 (11.91%) discontinued buprenorphine during the follow-up period, with a mean time to discontinuation of 97.92 (±68.64) days. Survival analysis revealed that patients who received antidepressants had a significantly lower hazard of discontinuation [aHR (95% CI): 0.995 (0.994, 0.996); .0001]. Initiated dose of buprenorphine also had a significant effect on the hazard of discontinuation [0.976 (0.956, 0.997); .0270]. Our findings support the notion that continuation of antidepressants when initiating buprenorphine therapy for OUD positively influences buprenorphine retention among patients with OUD and concurrent depression.

: This study evaluates the feasibility and acceptability of delivering Mindful Self-Compassion (MSC) to veterans with moral injury and co-occurring PTSD and substance use disorder (PTSD-SUD). : Veterans (N = 26; M age = 50.92; 100% male) were recruited for an 8-week MSC group. Participants completed measures of self-compassion, guilt, shame, PTSD, and substance use outcomes at baseline, post-treatment, and one-month post-treatment. : The recruitment target was easily met, and dropout rates were low (30.8%) for a comorbid veteran sample. Participants reported satisfaction with the intervention. Clinically meaningful change was examined for self-compassion, trauma-related symptoms, and substance use. A clinically meaningful increase for self-compassion and clinically meaningful decreases in PTSD symptoms, guilt, shame, and number of drinking days were observed. : The open-label design and small sample size preclude conclusions regarding efficacy. However, these preliminary findings are encouraging and suggest further investigation of MSC as a compliment to existing trauma-related therapies (NCT03681288).

Explore local leaders' perceptions of substance use and psychosis treatment to inform the implementation of an assertive community treatment model for historically marginalized youth. Interviews were conducted with local leaders in a Northeast city with relevant expertise. Interviews were recorded, transcribed, and analyzed using the Consolidated Framework of Implementation Research domains. Fifteen leaders completed interviews and four key themes emerged: (1) A patchwork of systems attempts to catch youth early on, but often fails; (2) The inability to simultaneously address mental health and substance use concerns complicates care; (3) An ideal program would be flexible in the ways the current system is inflexible; (4) factors important in tailoring a program to serve historically marginalized youth. When designing a program to support the engagement of youth with symptoms of psychosis and SUD, it is important to take a patient-centered and flexible approach that accounts for the community-based setting.

Alcohol Use Disorder (AUD) is comorbid with major mental illnesses, but prescribing rates for medications for AUD (mAUD) are low. We surveyed 71 mental health and 42 substance use disorder (SUD) treatment providers in an academic medical center about AUD treatment practices. Fifty-three mental health and 14 SUD providers responded. Among the n = 22 mental health prescribers, a minority (29%) prescribed mAUD often. Sixty percent of mental health providers viewed mAUD as effective. Barriers to mAUD prescribing in mental health included believing SUD providers were better equipped to prescribe mAUD, whereas SUD providers assumed that patients were not interested in mAUD. All providers were willing to participate in mAUD education initiatives, but few were willing to engage in more time-intensive implementation activities. Improving knowledge and attitudes may improve mental health provider delivery of mAUD, but evidence-based strategies for improving prescribing may be less acceptable and feasible for providers.

Individuals who use opioids are at elevated risk of posttraumatic stress disorder (PTSD). The objective of this study was to examine the influence of PTSD diagnosis on opioid use outcomes over a 60-day period. Participants were individuals with a history of trauma and recent opioid use who were recruited from the community ( = 43.45 years; 54.8% white). Participants were administered a structured diagnostic assessment for PTSD during a baseline session, and reported 30-day opioid use, opioid treatment engagement, impaired control around using opioids, and opioid overdose using a Timeline Follow-back during baseline ( 84) and follow-up ( 56) sessions. Multilevel models were used to examine the influence of PTSD on change in opioid use, treatment, and impaired control over the course of the 60-day observation period among the 56 individuals that completed follow-up interviews. Two-thirds of the sample had a diagnosis of PTSD (66.7%). Compared to those without PTSD, individuals with PTSD were less likely to decrease opioid use ( = 1.04, 95% CI [1.02, 1.06], < .001), but were not more likely to report episode of impaired control ( = 1.02, 95% CI [0.98, 1.06], = .268), over the 60-day period. Although individuals with PTSD were less likely to increase their engagement with opioid treatment ( = 0.96, 95% CI [0.95, 0.97], < .001), these individuals engaged in treatment at much higher levels compared to individuals without PTSD. Findings underscore the high prevalence and impact of PTSD on opioid use outcomes among trauma-exposed community individuals who use opioids.

This systematic review describes studies focussed on co-occurring mental health and substance use (MH/SU) conditions among Aboriginal and Torres Strait Islander people, including the: characteristics; co-occurring conditions examined; cultural methodological quality; traditional scientific methodological quality of studies; and study outcomes. A systematic review examined the literature on co-occurring MH/SU conditions among Aboriginal and Torres Strait Islander people. Four databases were searched, with data from relevant studies extracted for narrative synthesis. Twelve articles (11 studies) were included. Nine studies used cross-sectional designs; one was a qualitative study and one a mixed methods study with a nested randomized controlled trial. Cultural methodological quality was low across the studies, with a maximum of 7 out of 14 criteria met. Thirty-three combinations of co-occurring conditions were examined. Most research to date has been cross-sectional with limited research exploring the effectiveness of treatments for co-occurring MH/SU conditions. Further Indigenous-led research is needed to find culturally safe, responsive and effective solutions in reducing the burden associated with MH/SU conditions and improving wellbeing.

People may consume alcohol as a self-medicating strategy to cope with the stressors of the COVID-19 pandemic. The study evaluated COVID-19 stresses in distinguishing nondrinkers, moderate drinkers, and binge drinkers as guided by the self-medication hypothesis. Adults ( = 484) answered a question assessing drinker type (nondrinkers vs. moderate drinkers vs. binge drinkers) and completed the COVID-19 Stress Scales embodied by the subscales of danger and contamination stress, socioeconomic stress, xenophobia stress, traumatic stress, and compulsive checking stress. Discriminant function analysis using the set of five COVID-19 stress subscales as predictors statistically classified participants into nondrinkers, moderate drinkers, and binge drinkers for the male and female samples. Afterward, 2 (gender: males vs. females) × 3 (drinker status: nondrinkers vs. moderate drinkers vs. binge drinkers) factorial multivariate analysis of variance (MANOVA) and analyses of variance (ANOVAs) scrutinized mean differences. Specifically, males compared to females experienced significantly higher socioeconomic stress, xenophobia stress, traumatic stress, and compulsive checking stress, but no gender difference was exhibited for danger and contamination stress. Furthermore, binge drinkers compared to nondrinkers reported significantly higher scores on all the COVID-19 stress subscales. Binge drinkers compared to moderate drinkers endorsed significantly higher scores on all the COVID-19 stress subscales. Moderate drinkers compared to nondrinkers exhibited significantly higher scores on all COVID-19 subscales except for danger and contamination stress. The findings are consistent with the self-medication, such that people experiencing more COVID-19 pandemic stresses are more likely to consume alcohol in heavier quantities.

Homelessness is a significant social issue in developed countries, linked to high rates of substance use, psychiatric disorders, and chronic somatic health conditions, which contribute to premature mortality. Despite Denmark's comprehensive welfare system, marginalized groups, including people in homelessness, face barriers to accessing healthcare, resulting in increased use of acute care services and poorer health outcomes compared to the general population. This study examines the health burden and mortality of some of Denmark's most marginalized individuals by analyzing registry data from users of a low-threshold healthcare service placed at the open drug scene in Copenhagen, Denmark. This retrospective cohort study spans seven years (2009-2015). The study includes 1,242 individual health service users identified through patient records from the low threshold service linked with demographic, educational, and healthcare utilization data from Danish registries. No approval from the Danish Research Ethics Committees for the Capital Region was needed since only national registers were used. The population was predominantly male with a median age of 42 years. Most participants were of ethnic Danish origin and had low educational attainment. This study revealed high morbidity, with significant proportions of the population affected by somatic diseases, psychiatric disorders, and substance use disorders, including 56% with Dual Diagnosis and 53% with Dual Diagnosis and somatic disease (Triple Diagnosis). Analysis of mortality showed 158 deaths, predominantly among males, with substance use-related causes and cardiovascular diseases being the leading causes of death. The mean age at death was 47.3 years, with a notable proportion occurring at a relatively young age. Our study reveals a high prevalence of both somatic and psychiatric disorders among the shelter health clinic users. Findings indicate that they are in a similar or often poorer health state than Danish shelter users overall, with a high prevalence of dual diagnoses alongside chronic somatic diseases (Triple Diagnosis) and early disease onset. This highlights the need for targeted support and the implementation of primary prevention measures to slow disease progression and improve healthcare access.

This rapid review and meta-analysis explores two hypotheses. First, people with a concurrent mental health and substance use disorder (SUD) respond less favorably to currently utilized treatment interventions, than do those with a single disorder. Second, the potential for certain already vulnerable groups including women, members of racialized minority groups and those who live in or near poverty may be even further disadvantaged.

Nearly half of people with early psychosis report lifetime problematic substance use. Current treatments have limited impact on substance use and supporting the client's family could improve recovery. The current study explored: (1) the impact of substance use and early psychosis on the family, and (2) experiences with their client relative's treatment. Participants were family members ( = 19) of clients with early psychosis and substance use. We used quantitative and qualitative data from the Community Reinforcement and Family Training for Early Psychosis and substance use (CRAFT-EP) pilot study to assess family members' views. Many participants reported concern about the client's cannabis use and its negative impact on family wellbeing and communication, with most participants wanting more guidance on how to support the client's treatment. Implementing family interventions are needed to improve family relationship quality and communication to promote recovery among people with early psychosis who use substances.

We aimed to evaluate the diagnostic accuracy a rapid 9-item peer-administered questionnaire, the Quick Screening Tool (QST), to detect urgent mental health symptoms in an urban community setting in France of People who use drugs (PWUD). Participants were recruited through Respondant-Driven Sampling. We used modules from the Mini International Neuropsychiatric Interview as the reference standard (current major depressive episode, suicidal risk, or current psychotic disorder). We calculated the area under the curve as well as sensitivity and specificity. Thirty-four percent of the 175 participants were assessed as in need of urgent mental care. The prevalence for depressive episode, suicidal risk and current psychotic syndrome was 11%, 19%, and 8%, respectively. The QST had an area under the curve for the detection of urgent psychiatric symptoms of 0.82. With a cutoff of 3, it had a sensitivity of 83.3% and a specificity of 64.4%. The performance of the QST in screening for urgent mental health symptoms was satisfactory. This questionnaire could be more broadly used in hard-to-reach PWUD populations in community-based interventions.

Substance-induced psychosis (SIP) is a prevalent psychotic disorder among patients with substance use disorders. SIP implies clinical severity, including suicidal behaviors. To date, few studies have focused on suicidal behaviors among patients with SIP. This study aimed to perform a scoping review to summarize the current findings on suicidal behaviors in patients with SIP and outline the implications for clinical practice.

The primary objective of this study was to assess the association between psychiatric comorbidity and current substance use in a sample of patients with opioid use disorder (OUD) receiving opioid agonist treatment (OAT) with methadone in outpatient drug treatment centers. Secondary objectives were: (a) to examine the associations between socio-demographic and clinical characteristics and specific substance use (opioids, cocaine, alcohol, cannabis), and (b) to identify the socio-demographic and clinical factors associated with substance use based on lifetime psychiatric comorbidity status.

This study examined feasibility, acceptability, and preliminary clinical impact of Veterans Affairs Coordinated Anxiety Learning and Management- Substance (VA CALM-S), a computer-assisted, transdiagnostic cognitive behavioral intervention for co-occurring anxiety and substance use disorders (SUDs) among veterans.

People with a psychotic disorder are more likely to experience pain and interference from pain in their daily lives. There is also a high prevalence of cannabis use among people with psychotic disorders, which is known to be effective in pain management. This study investigates whether pain is a predictor of cannabis use in people with psychosis. Since sedating antipsychotics may also suppress pain, this is included as a covariate. This sample included 108 Dutch people with a psychotic disorder, participating in the VAT observational cohort study. Cross-sectional regression analyses were performed with cannabis use (yes/no and units per week) as outcomes, and pain and the degree of interference from pain (RAND-36-SF items 7 and 8) as predictors. Covariates included were age, sex, severity of psychosis, and use of sedating antipsychotics. In this sample, 59% experienced some degree of pain and 18.5% used cannabis. Pain and interference from pain were not significant predictors of cannabis use, nor of the amount of cannabis use. However, the use of antipsychotics with low sedating effects was associated with a greater amount of cannabis use in our participants ( = .028). We found no direct link between pain experience and cannabis use in people with psychotic disorders. It is possible that cannabis effectively suppresses the pain, and participants using cannabis therefore did not report experiencing pain. Furthermore, our finding that participants who were prescribed antipsychotic drugs with low sedating effects use more cannabis warrants further investigation. It is possible that people with psychotic disorders who experience numbness and sedation from their antipsychotics, may be less inclined to attempt to reach these effects using cannabis, which could potentially influence the choice of prescribed antipsychotics in the treatment of psychotic disorders in the future.

Posttraumatic stress (PTS) symptoms and problematic alcohol use (e.g., binge drinking and alcohol-related problems; ARP) commonly co-occur following stressors and traumatic events. Ecological momentary assessment methods can clarify the functional relationships between these conditions.

U.S. Food and Drug Administration (FDA)-approved medications for Opioid Use Disorder (MOUD) effectively reduce opioid cravings, use, relapse, and overdose. However, adherence to MOUD is a significant challenge. Depression relates to poorer adherence across several medical conditions and may be a prime factor relating to poor MOUD adherence. The goal of this meta-analysis is to quantify the relationship between depression and MOUD adherence and to identify moderators of this association. A systematic literature search was conducted using PsycINFO, PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature [CINAHL] databases. Pearson's was used for the effect size statistic. A random effects model was utilized for all effect size analyses. Nine studies met eligibility criteria, with a total of 3493 participants. Higher baseline depressive symptoms were found to predict greater prospective adherence to MOUD ( = 0.130, 95% : 0.060-0.199, < .001). This effect was not moderated by the MOUD type or depression measurement type. In contrast to prior medical adherence research, depression predicted better, not poorer, adherence to MOUD. The literature was limited by few studies examining naltrexone, limited diversity of samples, and a lack of clear consensus on adherence measurement. Future research should test whether this relationship extends to naltrexone; use samples with more racial minorities, women and gender minorities, and inpatient samples; clearly define and measure adherence, and identify mechanisms and moderators of this relationship, to best inform future clinical applications and improve outcomes for those with OUD.

Bipolar Disorder (BD) is often complicated by co-occurring substance use disorders (SUD). We assessed the prevalence of SUD among BD hospitalization episodes and analyzed its association with hospitalization outcomes.

Motivational interviewing (MI) is a client centered counseling approach which aims to promote behavior change by enhancing patient motivation through the exploration and resolution of ambivalence. This type of psychotherapy, initially designed for the treatment of substance use disorders (SUD), is now seen as an effective way to manage chronic physical and psychiatric diseases. Patients with Dual Diagnosis (DD), people who simultaneously have a SUD diagnosis and a mental illness, are a complex group of psychiatric patients who have a particularly low treatment engagement. It was hypothesized that MI could be a valuable add-on therapy for DD patients. This review summarizes the main findings of randomized controlled trials applying MI to patients' psychiatric diagnoses and substance use. We aim to clarify previous inconsistent results regarding MI effectivity in this complex and challenging disorder.

Cannabis use contributes to negative psychosocial outcomes among youth in Early Psychosis Intervention (EPI) programs and families are crucial to recovery. This study sought to understand how youth in EPI programs perceive their families to influence their cannabis use and how cannabis affects family relationships.

Early leaving in substance use disorder treatment may be the single largest variable undermining treatment success. Existing work on early leaving tends to explore either client factors, which include age, race, gender, and diagnoses, or treatment factors, which include the type of treatment activities offered, treatment experiences of clients and staff, treatment amenities, and environmental factors in the residential treatment program. However, existing work on both client factors and treatment factors provides mixed results on what contributes to early leaving. Further, there has been very little research in the private residential treatment setting. This study aims to explore the factors influencing early leaving in a private residential treatment setting. The study analyzed admission and treatment records from 247 consecutive clients at a private treatment facility in Southern California to identify factors related to shorter retention. The program employs a biopsychosocial approach and evidence-based practices to assist clients in recovery from substance use disorders and mental health conditions. We utilize a battery of client measures, including the Outcome Questionnaire 45.2, Trauma History Questionnaire, as well as demographic and psychiatric variables in our analyses. Findings challenge previous research by showing that age and gender do not predict shorter retention, contrary to findings in the extant literature on public treatment centers. Instead, clients with higher symptoms of distress stay longer, as indicated by scores on the Outcome Questionnaire 45.2. Additionally, we find the majority of the cohort stayed in residential treatment for more than 30 days, with the average length of stay being 47.92 days, indicating that treatment completion of clients with severe symptomatology for an extended time in treatment (30 days or more) is achievable. The study underscores the importance of considering client symptomologies and severities in understanding and improving retention in substance use disorder treatment programs. This study highlights the potential impact of treatment services offered in private settings on client retention.

: To examine associations between employment-based self-regulatory processes and meaningful employment attainment among veterans with co-occurring conditions. : A survey was administered to a national Qualtrics panel of 534 employed veterans self-reporting mental health and substance use conditions. We tested whether career exploration, goal clarity, job-searching skills, and self-regulation skills explained unique variance in meaningful employment beyond other relevant predictors: mental health symptoms, alcohol and drug use severity, economic constraints, marginalization, job prestige, and employment status. : Hierarchical regression analysis revealed career exploration, goal clarity, job-searching skills, and self-regulation skills were significantly associated with meaningful employment beyond other predictors. Job prestige, employment status, and mental health symptoms also had significant associations with meaningful employment, while economic constraints and alcohol use lost significance in the final model. : Interventions promoting exploration, goal clarity, job-searching, and self-regulation may improve meaningful employment attainment while buffering the effects of alcohol use and economic constraints.

Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) represents a prevalent and problematic comorbidity. Functional health literacy (FHL) may play a role in this comorbidity based on its previously documented role in hazardous drinking. The current study examined functional health literacy (FHL) regarding hazardous drinking among a sample with probable posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). The current study is a secondary analysis of data from a project studying the transdiagnostic risk and maintenance factors of PTSD and hazardous alcohol use among people with probable PTSD and AUD. Participants were 565 nationally recruited adults with probable PTSD and hazardous alcohol use (52.2% female, 68.8% non-Hispanic White, average age = 39.2 years ± 10.9 years). Linear regression models were conducted regressing hazardous alcohol use onto PTSD symptoms and FHL scores. An interaction term between FHL and PTSD symptoms was included in the regression models with age, biological sex, race, and income included as covariates. Low FHL maintained a statistically significant role in predicting greater hazardous drinking ( < .001) even in the context of posttraumatic stress. High posttraumatic stress also emerged as a statistically significant predictor of hazardous alcohol use ( < .001). The interaction term between FHL and PTSD was not found to be a significant predictor of hazardous alcohol use ( = .222). FHL may be a relevant variable for better understand hazardous drinking among persons with comorbid PTSD and AUD.

The authors aimed to conduct a systematic review and meta-analysis of the proportion of dual diagnosis patients in the clinical setting. Researchers searched MEDLINE and Google Scholar from inception until July 2024. Observational, retrospective, and cohort studies that reported the proportion of patients with dual diagnosis in a clinical setting were included. Random-effects meta-analysis and risk of bias assessment were conducted, along with subgroup and sensitivity analysis. The sample included 32 studies (cumulative  = 2,805,009) and found high heterogeneity among the studies, which persisted in the subgroup analysis. The median proportion was 47.90% (ranging from 5.9% to 91.55%), with a pooled proportion of 44.70% (95% confidence interval, 0.28 to 0.63). Dual diagnosis is highly prevalent in clinical settings with variability in prevalence based on different settings, assessment methods, and country of origin. Further research on dual diagnosis and due recognition for integrated management are required.