A peer-led integrated approach for co-existing mental and addictive disorders: a longitudinal qualitative study of the first UK dual diagnosis anonymous

Background People with comorbid of mental illness and addictive disorders (also known as “dual diagnosis”) generally present with multiple complex needs and are often affected by seriously adverse clinical and social outcomes and poor prospects of long term recovery. Yet, individual with such comorbidity are often failed by the social and healthcare systems. This can lead to individuals feeling isolated, marginalised and hopeless. Mutual aid groups are an invaluable source of social capital for those who are most at risk of isolation, however those with co-occurring disorders can feel alienated and not able to discuss their mental health issues in traditional AA and NA groups. Inspired by the success the Dual Diagnosis Anonymous (DDA) programme in Oregon, in 2016 the first DDA was founded to address the needs of individuals with comorbidity. DDA is an integrated peer-led group that adapts the traditional 12-steps programme by adding 5 extra steps and a workbook to specifically address mental health problems.

Aims The aims of the study were: (1) to investigate the DDA attendees’ perceived impact of the programme on their quality of life and recovery progression over a period of one year; explore what elements of the programme members perceived to be have been most useful and whether they had any suggestions for improvement; (2) to investigate the perspectives of DDA founders and facilitators on the effectiveness, challengers and future prospects of DDA and of (3) to explore the commissioner’s perspective on the usefulness and feasibility of such programme.

Method Six semi-structured interviews were conducted with 6 DDA attendees (at about 3 and 9 and 12 moths from the start of the programme), three DDA founders and facilitators (at 6 and 18 months from the start of the programme) and the one NHS commissioner who funded the pilot (one interview at 18 months). Data were thematically coded by two independent investigators, results were compared to patterns identified by the software NVivo. Themes and sub-themes were then discussed, agreed and presented to the DDA group. The feedback received from the group was utilized to finalise and interpret the emerged patterns. A longitudinal matrix was also used to evidence the trajectory of the development of each theme over time for each DDA member.

Main findings: overall, DDA members reported that the programme had improved their lives in the following areas: acceptance of self, of others and from others, increased hope, reduction of symptoms (mental health and addictive disorders), improved social functioning and advancement in self-development.

Conclusions: results of the interviews from DDA members, facilitators and the commissioner converged and suggested that the DDA programme is a valuable resource for the people with comorbidity and their community. Challenges and future developments will be discussed.