Alcohol use disorder and dual diagnosis : professionals’ perspectives on the provision of services to clients in Malta

Abstract

This study explores the experiences of professionals providing services to clients with Dual Diagnosis (DD), focusing on Alcohol Use Disorder (AUD) within the Maltese Islands’ unique sociocultural context, where alcohol occupies a strong cultural foothold. Against this backdrop, the research examines how professionals address, treat and manage DD. The study also investigates barriers to treatment, opportunities for intervention, and the most common co-morbid mental health conditions (MHC) accompanying AUD. Additionally, it examines the perspectives of professionals on the adequacy of local services for DD clients. Guided by a qualitative methodology and positioned in an interpretivist biopsychosocial framework, this study aims to capture the experiences and perspectives of Maltese professionals working in the field of addiction. Five semi-structured interviews were conducted with a psychologist, a therapeutic facilitator, two social workers and a psychiatric nurse recruited through purposive sampling from treatment services in Malta and Gozo. Adopting Braun and Clarke’s six-step Thematic Analysis framework key patterns and themes were generated from the transcribed interviews. This inductive approach allowed themes to emerge organically, capturing the rich and nuanced perspectives of participants. A lack of resources, stigma, and institutional delays were the most frequently mentioned systemic barriers, yet embedded within these challenges were windows of opportunity, and turning points, such as moments of personal insights, small but significant achievements and external support that underscored the potential for meaningful change and recovery. The findings also highlight the need for more integrated service provision. Professionals often face a fragmented service infrastructure that exacerbates gaps in care, highlighting the pressing need for cohesive, forward-thinking strategies to address the complex needs of this client group. This study contributes to the limited research on AUD and DD locally, providing a deeper understanding of the challenges faced by professionals, and identifying opportunities to enhance service provision. The findings offer valuable recommendations for culturally sensitive, evidence-based strategies to improve treatment outcomes for individuals with DD.