What question did this study set out to answer?

The aim is to explore treatment practices and challenges faced by psychiatrists managing dual diagnosis in Italy.

July 3, 2026Open Access

Current Practices in the Treatment of Dual Diagnosis: Insights from a Nationwide Survey of Italian Psychiatrists on Pharmacological and Nonpharmacological Approaches, Challenges, and Limitations

SCS ChiappiniSaint Camillus International University of Health and Medical Sciences VRValerio RicciUniversity of Teramo SFSergio De FilippisUniversity of Siena

Key Points

The aim is to explore treatment practices and challenges faced by psychiatrists managing dual diagnosis in Italy.
Nationwide survey using a self-administered online questionnaire for psychiatrists in Italy.
Survey covered demographics, treatment approaches, organizational barriers, and collaboration between services.
Data were analyzed descriptively to identify practice patterns and intervention priorities.
78% of psychiatrists treated dual diagnosis patients, but only 38% had structured protocols.
Integration of health services was rated partially effective by 44%; 61% preferred integrated treatment.
Barriers included insufficient specialized training (67%) and insufficient resources (61%).

Abstract

Objective: This study investigated current clinical practices, organizational barriers, and resource availability in managing dual diagnosis (co-occurring psychiatric and substance use disorders) among Italian psychiatrists in a healthcare system characterized by service fragmentation between mental health and addiction care. Methods: A structured, self-administered online questionnaire was distributed nationwide to Italian psychiatrists. The survey covered demographic characteristics; organizational aspects and service collaboration; pharmacological and nonpharmacological approaches; and perceived clinical challenges. Data were analyzed descriptively to identify practice patterns and priority intervention areas. Results: Seventy-nine psychiatrists participated from diverse settings (38% addiction services, 25% community mental health services, 14% hospitals, 15% other facilities). While 78% regularly treated dual diagnosis patients, only 38% reported structured protocols between mental health and addiction services. Collaboration was rated as only partially effective by 44%. Integrated treatment was preferred by 61%. The most commonly prescribed medications included mood stabilizers (94%), atypical antipsychotics (68%), anticraving agents (54%), and antidepressants (37%). For depression, trazodone (32%) and serotonergic antidepressants (25%) were used most. For psychosis, aripiprazole (47%) was predominant. Most clinicians (81%) combined pharmacotherapy with psychosocial interventions. Key barriers included insufficient training (67% highlighted need for specialized clinicians), poor service integration, and diagnostic uncertainty. Conclusions: Significant gaps persist in Italian dual diagnosis care despite clinical awareness. Urgent priorities include routine screening, clinician training, national guideline development, organizational reforms promoting service collaboration, and increased availability of structural resources, which was reported as insufficient by 61% of respondents. These improvements are essential for delivering timely, evidence-based, integrated care to this vulnerable population.

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