Dual diagnosis resource needs in Spain: a national survey of professionals.
OBJECTIVE
Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain.


METHODS
We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology.


RESULTS
A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent.


CONCLUSIONS
According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.
a Departament of Psychiatry Hospital Universitario Gregorio Marañon , Madrid , Spain.
Nestor
N
Szerman
Pablo
P
Vega
Lara
L
Grau-López
Carmen
C
Barral
Ignacio
I
Basurte-Villamor
Beatriz
B
Mesías
Laia
L
Rodríguez-Cintas
José
J
Martínez-Raga
Miguel
M
Casas
Carlos
C
Roncero
D003625:Data Collection; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006282:Health Personnel; D006295:Health Resources; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000600:supply & distribution*; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*
addictive disorder; dual diagnosis; dual disorders; dual pathology; mental health disorder, health care professionals; professionals’ perception; resources; substance use disorder