Dual Diagnosis Narratives and Their Implications for the Alcohol and other Drug Sector in Australia

Abstract

Dual diagnosis discourse, concerning people who are diagnosed with both mental health and substance use problems, has attracted little critical analysis. This article aids reflection on its implications for alcohol and other drug (AOD) treatment services. Qualitative analysis of 19 interviews with a purposive sample of service providers and public servants was validated with informants. Three contrasting narratives emerged—progressive (dual diagnosis discourse has lifted the sector to a level where services can better respond to complex needs in general); remedial (it has simply helped to improve the workforce's expertise in AOD treatment and “catch up”with mental health services); and radical (by patching a fragmented system it has dampened demands for major system reform). The diversity of views supports an argument for a metanarrative which, combining the strengths of the three narratives, continues to pioneer, to educate and, crucially, is explicitly conceptualized as part of a broader picture of well-resourced structural reform.