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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.

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