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Open Access Research article

Dual diagnosis clients' treatment satisfaction - a systematic review

Sabrina J Schulte1*, Petra S Meier2 and John Stirling3

Author Affiliations

1 International Studies Department, American University of Sharjah, P.O. Box: 26666, Sharjah, United Arab Emirates

2 School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK

3 Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, Manchester, UK

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BMC Psychiatry 2011, 11:64  doi:10.1186/1471-244X-11-64

Published: 18 April 2011



The aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD).


We examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings.


Across the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed.


High satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients.

Dual diagnosis; co-morbidity; integrated treatment; mental illness; satisfaction; substance misuse