Co-occurring mental health and substance use disorders (‘dual disorders’) are a key concern for policy and service planning in Europe, prompting calls for more integrated and coordinated care systems. This is according to a new European Union Drugs Agency (EUDA) miniguide released today, which explores how European countries are responding to the challenge.
The publication, Dual disorders: health and social responses, is part of the EUDA’s wider series of miniguides on evidence-based responses to drug-related problems in Europe. It examines how mental health disorders and substance use disorders can interact, complicating diagnosis, treatment and recovery.
Dual disorders, the co-occurrence of mental health and substance use disorders in the same individual, may arise simultaneously, sequentially or independently. Anxiety, personality and psychotic disorders are among the mental health conditions commonly associated with substance use problems, while alcohol, opioids, cocaine, cannabis and sedatives are the substances most frequently linked to dual disorders. Young people, individuals in custodial settings, people experiencing homelessness and women affected by trauma are considered particularly vulnerable.
The issue has gained greater visibility in Europe in recent years, particularly following the COVID-19 pandemic, when increased stress, social isolation and disruption to healthcare services contributed to worsening mental health and increased substance use among some groups. In 2023, the Council of the European Union called on Member States, the European Commission and relevant EU agencies to strengthen prevention, treatment and coordination for people with co-occurring mental health and substance use disorders through a set of priority measures (see Council conclusions). Today’s publication supports these efforts by bringing together the latest evidence and practice in this rapidly evolving area.
The miniguide outlines a range of interventions, including early detection and screening, integrated treatment approaches, psychosocial and pharmacological interventions, trauma-informed care and specialist workforce training. It highlights the importance of integrated care models based on the ‘no wrong door’ principle, ensuring that people can access coordinated support, regardless of where they first seek help.
Fragmented healthcare systems and limited specialist expertise continue to create barriers to effective responses. Examining current models of care in Europe, the miniguide shows that services are often concentrated in urban areas and coverage remains uneven. However, progress is visible, with some form of integrated services for dual disorders now available in a number of countries.
The resource stresses that improving care for dual disorders will require closer coordination between mental health and substance use services, better data collection and sustained investment in integrated systems. It also highlights the need for further research and improved monitoring of mental health conditions among people entering drug treatment in Europe. As part of these efforts, the EUDA introduced a standardised measure of mental health disorders into European drug treatment demand monitoring in 2024.
Scaling up integrated health and social responses will be essential to improving outcomes for affected individuals and strengthening Europe’s preparedness for future challenges. Alongside prevention and treatment, training professionals across service areas and improving continuity of care are identified as important steps towards more coordinated and effective support in Europe.
Later this year, the EUDA will organise a series of webinars on responding to dual disorders.
