Comprehensive care processes for substance use disorders in adult mental health services: A systematic review
Abstract
BACKGROUND AND OBJECTIVES: Assessment and care of substance use disorder within mental health services are essential due to the high prevalence and harms associated with comorbidity. Substance use disorder assessment and care are routinely recommended in clinical guidelines; however, processes are not agreed. This systematic review of routine clinical practice in relation to substance use disorders in adult mental health service aims to identify routine assessment and diagnosis processes, the proportion of patients and service episodes in which they occur and their outputs. METHODS: We searched MEDLINE, PsycINFO, Embase and relevant Cochrane databases for articles until July 2024 reporting on substance use assessment, diagnosis or treatment in adults receiving routine mental health service and locating additional articles by snowballing. Variables including setting, study method, period, cohort, substances, clinical assessment type, diagnosis and care pathways were compared. RESULTS: In 137 heterogeneous studies reporting routine practice within a wide variety of adult mental health service from 29 nations, 44 (32%) expected or reported on substance use assessment in domains of pattern or impact. However, 23 studies (17%) reported structured approaches to substance use disorder assessment, while 67 (49%) reported a diagnostic structure, including classification system. Diagnostic prevalence varied markedly. Treatment was reported in 16 studies (12%) and no substance use disorder outcomes were reported. CONCLUSION: This systematic review shows marked variation in routine practice in mental health service across a range of substance use disorder assessment and diagnosis processes. To better identify substance use disorder, enhance its care and reduce associated morbidity, adult mental health service may benefit from standardising expectations and systematically monitoring the performance of substance use assessment and diagnosis.
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Choi, N. G., & Marti, C. N. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22040640 · Cited by 8 · see citing works
“Given the high prevalence and harms associated with comorbid mental disorders and SUD, mental health providers are routinely recommended to assess SUD and provide care, and many do provide such services [20].”
Reilly, J., Lam, M., Sara, G. E., & Heffernan, E. (2026) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674261470582
Self-citationGalletly, C. A., Arunogiri, S., Hall, E., Parker, S., Sara, G. E., & Lappin, J. (2026) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674261475184
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- Authors
- Reilly, J., Meurk, C., Sara, G. E., & Heffernan, E.
- Affiliations
- Queensland Health (AU)
- The University of Sydney (AU)
- Corresponding author
- Reilly, John
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2025-01-16
- Volume
- 59
- Issue
- 3
- Pages
- 209-223
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W4406429012
- Cited by
- 4
- References
- 133
- Citations by year
- 2026: 3 · 2025: 1
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- substance use disorders, mental health services, substance use assessment, diagnosis, comorbidities, routine clinical practice, care pathways, diagnostic prevalence, standardization of care, adults
- MeSH terms
- Adult, Comprehensive Health Care, Humans, Mental Health Services, Substance-Related Disorders
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