ABSTRACT
This chapter considers the implications for primary care staff working with patients who appear to have both complex mental health needs in addition to abusing illicit and non-illicit substances. This is often referred to as dual diagnosis. However this term is the subject of debate because of its impact on care provision and the fact that the majority of people may have more than two diagnoses that may include the need for social care. Substance misuse is usual rather than exceptional amongst people with severe mental health problems and the relationship between the two is complex. Some people who misuse drugs may find that they experience symptoms such as suspiciousness, agitation, emotional liability, paranoid delusions, perceptual distortions and hallucinations. The development of a strong and trusting therapeutic relationship between the nurse and the client is significant in terms of engagement and the consideration and implementation of therapeutic interventions.
