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

Abstract

Dual diagnosis (DD) is increasingly recognised as the norm rather than the exception, with numbers continuing to rise and individuals commonly presenting with complex needs that go beyond single-service intervention. This study explores the experiences of professionals providing services to clients with DD, focusing on Alcohol Use Disorder (AUD) within the Maltese Islands’ unique sociocultural context, where alcohol occupies a strong cultural foothold. Guided by a qualitative methodology and situated within an interpretivist and constructionist paradigm, five semi-structured interviews were conducted with professionals recruited through purposive sampling from treatment services in the Maltese islands. Using Braun and Clarke’s Reflexive Thematic Analysis framework, key patterns and themes were generated from the transcribed interviews. A lack of resources, stigma, institutional delays and insufficient aftercare were the most frequently mentioned systemic barriers. Embedded within these challenges professionals also highlighted clients’ biopsychosocial difficulties as well as therapeutic turning points that underscored the potential for meaningful change and recovery for clients. 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.