Abstract
Background
Nursing care of patients diagnosed with dual diagnosis poses significant challenges such as limited resources, low levels of education, limited standardised treatment packages and guidelines. Understanding current approaches to providing nursing care for these group of patients is crucial, as it allows advancement in research towards improving patient outcomes and guidance for the nurses.
Aim
This comprehensive literature review seeks to synthesise literature on the current nursing care of patients diagnosed with dual diagnosis.
Method
The comprehensive literature review follows the guidelines by Onwuegbuzie and Frels. The search for records was conducted in four databases including CINAHL, MedLine PsycINFO, and ScienceDirect. Additional grey literature was searched with the help of Google Scholar. Keywords used were dual diagnosis, co-occurring disorders, comorbid, nursing care, nursing. A total of 7 articles met the eligibility criteria and were included in the review.
Results
The evidence from the synthesis reveals a complex interplay between systemic processes, therapeutic relationships, and intervention outcomes, with both psychosocial and pharmacological modalities contributing to patient recovery. Five overarching themes were identified: structural deficiencies in care planning and documentation, therapeutic relationships as the basis of engagement, efficacy of psychosocial interventions such as psychoeducation and skill-building and individual counselling for behaviour change, role of pharmacological interventions within integrated care such as lurasidone for psychotic symptom and craving reduction and long-acting injectable aripiprazole for functional gains, barriers to sustained engagement such as impact of medication side effects and relapse and insufficient aftercare and trauma-informed practices.
Conclusion
Nursing care of patients diagnosed with dual diagnosis is most effective when integrated, patient-centred, and combining psychosocial with pharmacological approaches. Therapeutic relationships, consumer engagement, and structured planning support recovery. However, documentation gaps, low participation, and poor aftercare remain barriers needing innovation, policy, and research.
Clinical trial number
Not applicable.
Keywords: Dual diagnosis, Nursing care, Nursing
Background
In this twenty-first century, the nursing care rendered to patients has undergone significant transformation, with the nursing care of patient diagnosed with dual diagnosis emerging as a significant challenge to modern day nursing due to its complex nature [1, 2] and the inadequacy of guidelines for nurses [2]. Dual diagnosis is the co-existence of mental disorder such as schizophrenia, bipolar disorder, posttraumatic stress disorder and depression and substance use disorder in one individual such as alcohol, cannabis opoids [3–5]. A review estimated that up to 75% of patient with severe mental disorder also have substance use disorder [6]. Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%).In Australia mood and anxiety disorders is reported to be particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75% [7]. Due to the fact that the condition is evolving in contemporary nursing practice [8], there is a growing challenge in providing nursing care to such patients globally as a result of the increasing numbers of cases, prompting the question on nursing care [9–12]. Nursing science in current times has revolutionised the way nursing care is provided to patients with peculiar needs, including patients diagnosed with dual diagnosis [6]. Patients diagnosed with dual diagnosis, in its different forms, have become common among mental health patients [6, 8]. The major concern regarding the care of patients diagnosed with dual diagnosis is the uncertainty of reaching the desired outcome [13–16].
Understanding the current nursing care of patients diagnosed with dual diagnosis is critical because it does not only reflect impact of advances in nursing science but also provides guidance for nurses who are frustrated when they encounter such patients [8]. In addition, patients diagnosed with dual diagnosis are likely to experience a positive outcome devoid of stigma and discrimination from nurses [8].
Despite ongoing discussions surrounding the challenges and the care of patients diagnosed with dual diagnosis, there is a patent absence of reviews that systematically table the evidence on current nursing care of patients diagnosed with dual diagnosis. Existing studies have primarily focused on treatment guidelines in general [17–20]. Given that research into patients diagnosed with dual diagnosis is emerging, and has shown significant variations in research questions and methodologies [17–20], there is an urgent need to conduct comprehensive literature review on the current nursing care to address some of the challenges confronting the nursing care of such patients. Synthesizing the evidence using comprehensive literature review methodology [21] is essential to streamline the current evidence on the nursing care of patients diagnosed with dual diagnosis.
This review provides an insight into the current findings on the nursing care of patients diagnosed with dual diagnosis, systematically highlighting the various forms of nursing care. It also offers guidance for future studies. Hence, the aim of this review is to synthesise current nursing care of patients diagnosed with dual diagnosis.
Methods
Research design
The review adopted the methodological framework proposed by Onwuegbuzie and Frels [21] for conducting comprehensive literature reviews. This approach involves the following seven key steps: exploring beliefs and topics, initiating the search, storing and organising information, selecting information, expanding the search, analysing and synthesising information and communication.
Exploring beliefs and topics
This comprehensive literature review began with the recognition that dual diagnosis, the co-occurrence of a mental health disorder and a substance use disorder, presents unique challenges for nursing care. Anecdotal clinical observations indicated wide variability in interventions, suggesting a need to synthesise available evidence on effective nursing strategies. Our belief entering the review was that integrated, multidisciplinary care models would be central to effective management. Reflexive journaling was used to note potential preconceptions to avoid undue bias during synthesis.
Initiating the search
Searches were conducted across CINAHL, MEDLINE, PsycINFO, Science Direct and, Google Scholar from 2018 to 2025 to locate recent literature, supplemented by manual reference list checks and grey literature searches. Keywords included dual diagnosis, concurring disorders, nursing care and nursing. Boolean operators (AND/OR) and database-specific subject headings (e.g., MeSH: dual diagnosis, Nursing) were used to optimise retrieval. See Table 1 below:
Table 1.
Search string used
| Current nursing care of patients diagnosed with dual diagnosis | Search string | No. of articles |
|---|---|---|
| 1. CINAHL (4th January, 2025) | Nursing Care AND dual diagnosis | 3 |
| Nursing AND dual diagnosis | 9 | |
| Filters: English language, 2018-2025 | ||
| 2. MedLine (6th January, 2025) | Nursing Care AND dual diagnosis | 3 |
| Nursing AND dual diagnosis | 7 | |
| Filters: English language, 2018-2025 | ||
| 3. PsycINFO (8th January, 2025) | Nursing Care AND dual diagnosis | 3 |
| Nursing AND dual diagnosis | 8 | |
| Nursing AND concurrent | 3 | |
| Filters: English language, 2018-2025 | ||
| 4. ScienceDirect (10th January, 2025) | Nursing Care AND dual diagnosis | 3 |
| Nursing AND dual diagnosis | 8 | |
| Filters: English language, 2018-2025 |
Eligibility criteria
The search for this CLR focused on national and international studies related to nursing care and treatment of patients either with substance use disorder, mental disorder or dual diagnosis. The search was limited to studies published in from 1st January 2018 to 10th January 2025. To ensure that the included studies represented current nursing care, studies published before 2018 were not considered. The search was restricted to studies published in English language.
Storing and organising information
The inclusion and exclusion criteria were established to guide the selection, storing and organisation of information for this review. The 2018 limit set of the period is to ensure that current articles based on current evidence are retrieved. A reference management system (Mendeley) was used to store retrieved records and duplicates were removed.
Selecting and deselecting the information
The inclusion criteria focused on patients with dual diagnosis with primary emphasis on nursing care or nursing-delivered interventions and published in peer-reviewed journals (January, 2018– January 2025) and available in English language. The reason for focusing on this period was to include only recent literature and English language because the researcher is more comfortable with the English language.
Eexpanding the search
Manual search was done with the assistance of a librarian to obtain to obtains additional sources of relevant data for the study.
Search results
The initial search across the main databases yielded 47 records and an additional 10 records from Google Scholar, resulting in a total of 57 records. Further, the elimination of 36 duplicates records using Mendeley software was performed. The screening was done by a postgraduate student and supervised by two competent promoters. The full-text of eligible abstracts and titles were then retrieved for further screening based on the inclusion and exclusion criteria. Upon screening the titles and abstracts, 8 records were excluded, leaving 13 full text records for concerted scrutiny. The reference lists of these identified full-text records were reviewed, contributing one additional eligible record. Though 14 full-text articles were reviewed for inclusion, the final articles that met the inclusion criteria for the comprehensive literature review were 7 with reasons provided for the other 7 records excluded due to a non-nursing focus. Figure 1 below presents the flow diagramme of the search result. The 7 articles [8, 22–27] that met the inclusion criteria are indicated in Table 2 below.
Fig. 1.
PRISMA Flow Diagramme of studies included
Table 2.
Included studies with their characteristics
| Author(s) | Year and Country | Aim/Purpose of the Study | Study Design | Population, Setting | Sample Size | Interventions | Key Findings | Recommendations |
|---|---|---|---|---|---|---|---|---|
| [22] | 2020, Australia | To examine the characteristics of consumers in a dual diagnosis inpatient service and explore documentation of assessed needs, care, and nonpharmacological interventions. | Retrospective exploratory study | Consumers with mental health and substance use disorders admitted to two dual diagnosis inpatient units in metropolitan Sydney | 36 healthcare records | Nonpharmacological interventions such as drug education, CBT, MI, relapse prevention, trauma-informed care (TIC), mutual aid, art therapy, etc. | Low rates of consumer involvement in care planning; poor documentation; rare use of SMART goals; minimal trauma-focused assessment/intervention; limited multidisciplinary planning; inconsistent use of outcome tools | Improve care planning with multidisciplinary and consumer collaboration; adopt trauma-informed care models; enhance training in SMART goal setting and outcome documentation; develop evidence-based guidelines for dual diagnosis care |
| [8] | 2019, Canada | To explore what nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by psychiatric inpatients with a dual diagnosis | Qualitative descriptive study using semi-structured interviews | Adult inpatients with dual diagnosis at Douglas Mental Health University Institute, Montreal | 12 participants | Interviews focused on perceived helpful nursing practices | Three themes of helpful care identified: promoting health in everyday living, managing mental illness with substance use, building therapeutic relationships | Emphasizes collaborative, strengths-based, evidence-informed nursing care that includes substance use as part of psychiatric care |
| [23] | 2018, United Kingdom | To determine the effectiveness of a 10-week psychoeducational group therapy on dual diagnosis patients | Quantitative, pre-post intervention study | Adults (18–65) with serious mental illness and substance misuse, in community mental health settings (e.g., Assertive Outreach Teams) | 51 completers (out of 80 enrolled) | Psychoeducational Group (PEG) therapy – 10 weekly sessions incorporating harm reduction, motivational and relapse prevention content | Significant improvements in psychological well-being and psychiatric symptomology; reduced use of most substances except heroin | Promote integrated care; simultaneous treatment for mental illness and substance misuse; emphasize multimodal and flexible treatment approaches |
| [24] | 2022, Malaysia | To illustrate intervention outcomes for a dual-diagnosis university student with alcohol use disorder and acute stress disorder | Qualitative case study | Female university student (22 yrs), outpatient counselling setting | 1 (single case study) | 6-session counselling using supportive psychotherapy, CBT, relaxation, psychoeducation, motivational interviewing, relapse prevention | Reduction in alcohol use, improved coping and mental well-being, progress in stages of change, restored family support | Continued counselling, journaling, breathing techniques; family therapy; encourage academic and personal goal pursuit |
| [25] | 2019, Ireland | To evaluate the effectiveness of a 24-week DBT skills-only programme for individuals with dual diagnosis | Mixed methods (explanatory sequential design) | Adults with dual diagnosis (emotional dysregulation and substance misuse), community-based public addiction service (Arbour House) | 64 | Adapted 24-week DBT skills training (U&ME-A programme), covering mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness | Significant improvements in emotion regulation, mindfulness, dysfunctional coping, and DBT skills use; reduced binge drinking and drug use; qualitative reports of increased confidence, emotional regulation, and reduced substance use. | Extend programme duration; provide formal aftercare support; explore use in children and adolescents; replicate study with control groups and more objective substance use data; better measure impact of medication use. |
| [26] | 2024, Italy | To assess the efficacy, safety, and tolerability of lurasidone in patients with schizophrenia spectrum disorder and co-occurring AUD/SUD | Prospective, multicentric, real-world study | Adults (18–65) with schizophrenia spectrum disorders and comorbid alcohol/substance use disorders, recruited from multiple psychiatric centres in Italy | 23 | Lurasidone (37–148 mg/day); dosage tailored to response. Assessed with PANSS, CGI, MOAS, VAS, Q-LES-Q-SF, and SF-36 over 1 month. | Significant reductions in psychotic symptoms (PANSS), cravings (VAS), and aggression (MOAS); improved quality of life (Q-LES-Q-SF, SF-36); generally well-tolerated; dropout rate 39.13% mainly due to side effects or relapse. | Lurasidone is a promising option for dual diagnosis; further studies with larger samples, longer follow-up, and control groups are needed. Integrated care and personalized approaches are essential due to high non-adherence. |
| [28] | 2020, Spain | To evaluate the efficacy of once-monthly long-acting injectable (LAI) aripiprazole in patients with schizophrenia and co-occurring substance use disorders (SUDs) | Multicentre, observational, descriptive, retrospective study | Patients with schizophrenia and co-occurring SUDs across five centres in Spain | 40 | LAI aripiprazole 400 mg every 4 weeks, sometimes with other psychotropic and psychotherapy | Significant improvements in CGI and WHODAS-2.0 scores; reduced substance use in alcohol and cocaine subgroups | Consider LAI aripiprazole as a useful treatment option for dual diagnosis involving schizophrenia and SUDs; call for randomized trials with long-term follow-up |
Extracting and recording information
A data extraction matrix captured citation details, the author, country, study purpose and design, setting and participants, type of intervention, key findings and reported outcomes and recommendations. See Table 2.
Analysing and synthesising information
Coding and categorising information
Coding was done to the extracted data generating 30 initial codes. See intial codes below. Codes such as care process and documentation issues, therapeutic relationship and engagement, psychosocial intervention outcomes, pharmacological intervention outcomes, barriers and challenges were identified. Five overarching themes emerged.
Initial 30 codes
Low consumer involvement in care planning.
Poor documentation of care plans.
Infrequent use of SMART goals.
Minimal trauma-focused assessment and intervention.
Limited multidisciplinary care planning.
Inconsistent use of outcome measurement tools.
Nurses promoting health in everyday living.
Support in managing co-occurring mental illness and substance use.
Building strong therapeutic relationships.
Collaborative and strengths-based nursing care.
Integration of substance use within psychiatric care.
Improved psychological well-being after psychoeducation.
Reduction in psychiatric symptoms.
Decreased substance use except heroin.
Effectiveness of multimodal and flexible treatment approaches.
Alcohol use reduction through supportive counselling.
Improved coping strategies.
Progression in stages of change.
Restored family support.
Improved emotion regulation after DBT skills training.
Enhanced mindfulness skills.
Reduction in dysfunctional coping.
Decreased binge drinking and drug use.
Increased confidence through skills training.
Reduction in cravings and psychotic symptoms with lurasidone.
Improved quality of life after pharmacological intervention.
Treatment generally well-tolerated.
High dropout due to side effects or relapse.
Reduction in substance use with long-acting aripiprazole.
Functional improvement (daily living activities.
Codes identified
Care Process and Documentation Issues
Low consumer involvement in care planning.
Poor documentation of care plans.
Infrequent use of SMART goals.
Minimal trauma-focused assessment and intervention.
Limited multidisciplinary care planning.
Inconsistent use of outcome measurement tools.
Therapeutic Relationship and Engagement
Nurses promoting health in everyday living.
Support in managing co-occurring mental illness and substance use.
Building strong therapeutic relationships.
Collaborative and strengths-based nursing care.
Integration of substance use within psychiatric care.
Psychosocial Intervention Outcomes
Improved psychological well-being after psychoeducation.
Reduction in psychiatric symptoms.
Decreased substance use except heroin.
Effectiveness of multimodal and flexible treatment approaches.
Alcohol use reduction through supportive counselling.
Improved coping strategies.
Progression in stages of change.
Restored family support.
Increased confidence through skills training.
Improved emotion regulation after DBT skills training.
Enhanced mindfulness skills.
Reduction in dysfunctional coping.
Decreased binge drinking and drug use.
Pharmacological Intervention Outcomes
Reduction in cravings and psychotic symptoms with lurasidone.
Improved quality of life after pharmacological intervention.
Treatment generally well-tolerated.
High dropout due to side effects or relapse.
Reduction in substance use with long-acting aripiprazole.
Functional improvement (daily living activities).
Barriers and Challenges
High dropout due to side effects or relapse (also linked under pharmacological outcomes).
Minimal trauma-focused interventions (also linked under care process issues).
The 5 overarching themes
Theme 1: Gaps in Care Planning and Documentation Practices.
Care planning for dual diagnosis patients was identified as poorly structured and inconsistently documented. In the Australian retrospective review [22], healthcare records revealed “low rates of consumer involvement in care planning” and “rare use of SMART goals,” with trauma-focused assessments and interventions described as “minimal” and “infrequent”. Outcome measurement tools were seldom used, and multidisciplinary input into care plans was limited. These systemic issues reduce the ability to track progress, adapt interventions, and ensure consumer-led recovery. Collectively, the findings highlight the need for “multidisciplinary and consumer collaboration” and the adoption of structured, trauma-informed care models.
Theme 2: Therapeutic relationships as foundations for recovery
Relational care emerged as a core facilitator of recovery in dual diagnosis treatment. In a Canadian qualitative study [8], participants described helpful nursing care as “promoting health in everyday living,” “managing mental illness with substance use,” and “building therapeutic relationships” that recognised the whole person rather than their diagnoses alone. Such approaches reflected a “collaborative, strengths-based, evidence-informed” philosophy, where substance use was addressed as an integrated component of psychiatric care. These interpersonal connections appeared to foster trust, encourage openness, and enhance patient engagement with treatment.
Theme 3: Positive outcomes from psychosocial interventions
Structured psychosocial interventions consistently yielded improvements in mental health and substance use outcomes. A UK pre–post study [28] of 10-week psychoeducational group therapy reported “significant improvements in psychological well-being and psychiatric symptomology,” alongside reduced use of most substances except heroin. Similarly, a Malaysian case study showed that supportive psychotherapy, CBT, and motivational interviewing led to a “reduction in alcohol use,” “improved coping,” and “restored family support,” with the client progressing through the stages of change.
Skills-based interventions, notably a 24-week DBT programme in Ireland [25], enhanced “emotion regulation,” “mindfulness,” and “confidence,” while reducing binge drinking, drug use, and dysfunctional coping strategies. These findings suggest that flexible, multimodal psychosocial programmes are particularly effective for this population.
Theme 4: Pharmacological treatments as adjuncts to integrated care
Pharmacological approaches, when embedded within integrated care, provided substantial benefits. In Italy [26], lurasidone treatment led to “significant reductions in psychotic symptoms (PANSS), cravings (VAS), and aggression (MOAS),” alongside quality-of-life gains measured by Q-LES-Q-SF and SF-36 scores. However, dropout rates reached 39%, primarily due to side effects or relapse. Similarly, a Spanish [29] multicentre study of monthly long-acting injectable aripiprazole showed “significant improvements in CGI and WHODAS-2.0 scores” and reductions in substance use—particularly alcohol and cocaine. These findings position pharmacological treatment not as a stand-alone solution, but as an important adjunct to psychosocial and behavioural interventions in dual diagnosis care.
Theme 5: Persistent barriers to sustained engagement
Despite the promise of integrated care, challenges in sustaining engagement remain. Medication side effects, relapse, and the absence of consistent trauma-informed approaches were recurrent barriers. Studies emphasised the need for “formal aftercare support,” retention strategies, and long-term follow-up to maintain gains. Importantly, even when interventions were effective, some participants disengaged due to systemic issues—such as poor coordination between services or inadequate personalisation of care—reinforcing the necessity of comprehensive, patient-centred treatment pathways.
Communication
Overall, the findings affirm that effective nursing care for patients with dual diagnosis centres on integrated, relationship-based, and multimodal approaches. Psychosocial interventions were consistently beneficial, but their success often depended on the strength of the therapeutic alliance and the extent of consumer involvement in care. Pharmacological interventions provided measurable symptom and functional gains but were undermined by adherence challenges.
Discoveries
The nursing care of individuals diagnosed with dual diagnosis involves a diverse range of interventions, reflecting the complex and multifaceted nature of care across different contexts. The variations in nursing practices underscore the influence of cultural, systemic, and contextual factors in shaping clinical approaches to dual diagnosis management. For instance, in the Ghanaian context, stigma around mental health and substance use may limit patient engagement which affects clinical outcomes negatively [30, 31], necessitating culturally tailored interventions such as community-based psychoeducation [31].
Studies reviewed reported a broad spectrum of interventions, encompassing both pharmacological and non-pharmacological modalities [8, 22–26, 29]. This range illustrates the inherent complexity in caring for patients with co-occurring mental health and substance use disorders [2]. For example, some studies focused on non-pharmacological interventions such as cognitive behavioural therapy (CBT), motivational interviewing (MI), drug education, relapse prevention, trauma-informed care (TIC), mutual aid, and art therapy [22]. In contrast, other studies utilised structured group-based interventions, such as psychoeducational group (PEG) therapy, incorporating elements of harm reduction, motivation enhancement, and relapse prevention [23].
Additionally, counselling strategies employing supportive psychotherapy, relaxation techniques, psychoeducation, and further motivational and relapse prevention approaches were highlighted [24], alongside helpful nursing activities aimed at supporting recovery and engagement in care [8]. These strategies suggest differing national preferences and practices in delivering nursing care to patients diagnosed with dual diagnosis, potentially driven by healthcare system structures, resource availability, training standards, and cultural attitudes toward mental health and substance use.
The diversity of approaches, ranging from pharmacological to psychosocial interventions, emphasizes the necessity for a better understanding of the context-specific drivers that shape nursing care for patients with dual diagnosis. This includes consideration of cultural influences, as well as the motivations of nurses and patients, which are critical for the development of tailored and effective clinical guidelines. Such insights are essential for addressing ongoing challenges in the nursing care of patients diagnosed with dual diagnosis and for improving the quality and consistency of nursing care across various settings.
Suggestions to improve nursing care of patients diagnosed with dual diagnosis
The nursing care of patients diagnosed with dual diagnosis necessitates a range of varied and context-sensitive approaches, reflecting the complexity and multifactorial nature of the condition. The literature highlights the need for integrated and holistic care models, driven by the recognition of gaps in comprehensive assessment and coordination in nursing practices for this population.
One central suggestion is the implementation of integrated care planning, which emphasizes multidisciplinary collaboration and active patient involvement [22]. This approach encourages a collaborative, strengths-based, and evidence-informed model of nursing care that recognises substance use disorders as an integral part of psychiatric care, rather than as a secondary concern. Such integration is vital for ensuring that treatment strategies are coherent, person-centred, and responsive to the complex interplay between mental health symptoms and substance use behaviours.
Suggested nursing interventions also include addressing basic and fundamental patient needs, such as nutrition, hygiene, and mobility, which are essential to patient stabilization and recovery. Alongside these physical care components, nurses are advised to provide simultaneous and coordinated treatment for both mental illness and substance use disorders. This includes interventions aimed at reducing illicit drug and alcohol use, managing psychiatric symptoms, and ensuring consistency in therapeutic interventions [8].
Another critical component of effective nursing care is the development of a strong therapeutic relationship. Building trust and rapport involves demonstrating empathy, compassion, and respect, as well as engaging with patients in humane and humanising ways. Nurses are encouraged to “get to know the patient” beyond their diagnosis and to express genuine care and commitment in their interactions. Such relational care is foundational to fostering patient engagement, enhancing treatment adherence, and promoting long-term recovery [8].
Limitations
Though the study employed a structured methodology, this comprehensive review is not without limitations. Its focus on English language publications might have excluded important contributions from non-English literature, introducing a language bias. Additionally,
the review may have preferentially extracted outcomes that appear significant or align with the study expectations, while overlooking negative or null results which may distort the balance of findings included in the synthesis. Albeit supervised, data extracted by the postgraduate student may have introduced risk of bias and converting findings into codes may have introduced misclassification or misinterpretation the review by the postgraduate student. The scope of the review and lack of critical appraisal might affect data consistency and reliability. Finally, the heterogeneity of the countries and population limit the findings’ generalisability.
Implications for practice, policy and research
The implications of this study are given in the following sections:
Implications for policy and nursing practice
To effectively address the challenge of nursing care of patients diagnosed with dual diagnosis, a strategy that harmonises guidelines for the nursing care of patients diagnosed with dual diagnosis is indispensable. Robust nursing care should be culturally sensitive, focusing on nursing ethics, consent, patient preferences and responsible nursing conduct. Additionally, comprehensive dual diagnosis literacy educational programmes need to emphasise critical thinking skills, highlighting ethically appropriate nursing care. Policy frameworks should prioritise preventive strategies, patient privacy and ethical nursing practice in all nursing educational institutions and the ministries of health policy frameworks. Stakeholder collaborations among educational institutions, policymakers, mental health experts and alcohol and substance abuse experts. Contextualising nursing care to respect diverse cultural norms is critical, acknowledging the different perspectives nursing care of patients diagnosed with dual diagnosis across varied societies.
Practical implications include implementing comprehensive nursing care of patients diagnosed with dual diagnosis into mental health nursing education that introduces the subject of nursing care into nursing and Midwifery curriculum. Enhancing literacy in the nursing care of patients diagnosed with dual diagnosis through workshops that teach student nurses and professional nurses how to care for such patients is also crucial. Furthermore, policy development by the Nursing and Midwifery Councils and Boards should fashion out clear nursing care guidelines within hospitals where such patients are found. Community involvement is important, engaging families, community leaders and organisations in discussing the challenges surrounding dual diagnosis and how to prevent and provide support for them.
Implications for research
Continuous research and timely dissemination of information are crucial for gathering data on the effectiveness of these initiatives and adapting them to improve the nursing care of patients diagnosed with dual diagnosis. It is important to address the social views on discussing persons with mental health disorders and substance use disorders in the global space. Social views are conservative, with strong cultural and religious influence that centre on stigmatisation and discrimination regarding dual diagnosis. These factors have resulted in limited research and the unwillingness among scholars to engage on dual diagnosis. Acknowledging these challenges could help provide researchers and practitioners with a lucid understanding of the social dynamics in societies across the globe and explain the scarcity of related studies that reflect the broader context which this article addresses.
Suggestions for future studies
Future Comprehensive Literature Reviews could consider addressing the limitations of this review by including non-English literature, employing more exhaustive databases and search terms to enhance comprehensiveness and mitigate potential biases. Moreover, examining the influence of societal perceptions on the nursing care of patients diagnosed with dual diagnosis could offer targeted interventions and policy frameworks.
Conclusions
Nursing care for individuals with dual diagnosis is most effective when embedded within an integrated, patient-centred framework that combines psychosocial and pharmacological approaches. Strong therapeutic relationships, consumer engagement, and structured care planning are central to positive outcomes. Yet systemic barriers, particularly weak documentation, low consumer participation, and inadequate aftercare, continue to undermine progress. Addressing these gaps through coordinated practice innovation, targeted policy reform, and implementation of focused research will be fundamental to advancing recovery and quality of life in this complex population.
Acknowledgements
None.
Abbreviations
- CBT
Cognitive Behaviour Therapy
- CGI
Clinical Global Impression Improvement
- DBT
Dialectical Behaviour Therapy
- LAI
Long-Acting Injectable
- MI
Motivational Interview
- MOAS
Modified Over Aggression Scale
- PANSS
Positive and Negative Syndrome Scale
- PEG
Psychoeducational Group
- Q-LES-Q-SF
Quality of Life, Enjoyment and Satisfaction Questionnaire Short Form
- SMART
Specific, Measurable, Achievable, Realistic and Time-bound
- SUDs
Substance Use Disorders
- TIC
Trauma-Informed Care
- U&ME
Understanding and Managing Emotions
- VAS
Visual Analogue Scale
- WHODAS
World Health Organisation Disability Assessment Schedule
Author contributions
Conceptualisation, F.N. and A.L.S; methodology, F.N., M.M. and A.L.S; data extraction, F.N., M.M; original draft preparation, F.N.; review and editing, A.L.S.; supervision, A.L.S. and M.M.
Funding
The research received no funding.
Data availability
All information is included in the manuscript; however, this can be made on reasonable request through the corresponding author.
Declarations
Ethical approval
Not applicable.
Informed consent
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
All information is included in the manuscript; however, this can be made on reasonable request through the corresponding author.