Understanding Dual Diagnosis in Healthcare

This assignment delves into the complexities of dual diagnosis, focusing on qualitative research methods used to understand the experiences of patients with co-occurring mental health and substance use disorders. It examines relevant literature and theories surrounding dual diagnosis, emphasizing the importance of integrated treatment approaches. The assignment requires students to critically analyze research findings, discuss challenges in diagnosis and treatment, and propose recommendations for improving care for individuals with dual diagnoses.

Running head: RESEARCH PROPOSAL
Research Proposal
Name of the Student
Name of the University
Author Note

1
RESEARCH PROPOSAL
Table of Contents
Topic..........................................................................................................................................3
Introduction................................................................................................................................3
Background of the study........................................................................................................5
Rationale of the study.............................................................................................................8
Aims and objectives...............................................................................................................8
Literature Review.......................................................................................................................9
Pharmacological interventions and its drawbacks...............................................................10
Non-pharmacological interventions and its drawbacks.......................................................10
Lack of personalised approach.............................................................................................12
Stigmatization of the patients with dual diagnosis...............................................................12
Research Gap.......................................................................................................................13
Methodology............................................................................................................................14
Research philosophy............................................................................................................14
Research approach...............................................................................................................14
Research design....................................................................................................................14
Data Collection.....................................................................................................................15
Interview Question...............................................................................................................16
Sampling and Participants selection.....................................................................................16
Data analysis........................................................................................................................17
Ethical consideration............................................................................................................17

2
RESEARCH PROPOSAL
Conclusion................................................................................................................................19
Time Plan of the research.........................................................................................................19
Grant Chart...........................................................................................................................19
References................................................................................................................................21

3
RESEARCH PROPOSAL
Topic
Improvement of treatment services for patients with dual diagnosis- a qualitative research
Introduction
The concept of dual diagnosis emerged as a significant concept in the last two decades
and has since been a prominent area of research. Attempts have been made by researchers
across the globe to analyze the implications of dual diagnosis for healthcare system. The
subject of dual diagnosis has been denoted to be a critical one, with researchers stating that
intensive research is required in this field. Dual diagnosis is described as the diagnosis made
in people suffering from a mental illness or psychiatric disorder, and a substance abuse
disorder. It is the dual nature of the affliction of the individuals that remains, at many
instances, undiagnosed and untreated. Difficulty in treating dual diagnosis patients leads to
sky-high likelihood of relapses (Rocco, Manera and Bellio 2017).
Mental illness and substance abuse are co-occurring at an alarming rate. Causes of
such co-morbidity have been attributed to genetic vulnerability, self-medication, lifestyle or
environment, common neural substrate and shared origins. According to de Waal et al. (2018)
it has been well documented in literature that individuals who suffer from alcohol or
substance abuse disorders have higher chances of suffering from a co-existing mental health
illness. Such disorders can be depression, anxiety or any other condition. Studies have
reported that almost 50-80% of clients who suffer from substance abuse are found to be
suffering from mental illness. As per the research of Lehman and Dixon (2016) dual
diagnosis is repeatedly being found to be the rule instead of the exception. A study of patients
suffering from bipolar disorder and poly-substance abuse were found to be suffering from
more mental illness symptoms. Patients who had alcohol dependence showed more signs of

4
RESEARCH PROPOSAL
depression and those with cannabis dependence had manic symptoms when a comparison
was done with individuals with no substance use disorder. The symptoms of dual diagnosis
are difficult to point out. The symptoms vary greatly since a number of combinations of dual
diagnosis are likely to occur. Numerous screening tools are being used for identification of
the people who are at risk for substance abuse after mental disorders has been diagnosed
(Ogloff et al. 2015).
As opined by McGovern et al. (2014) the most suitable treatment option for
addressing needs of dual diagnosis patients is integrated interventions. Integrated
interventions refer to the delivery of care against both substance abuse and mental illness.
The current notion that emerges in the clinical field is that both the issues in dual diagnosis
are to be addressed simultaneously. Treatment planning is not the same for all patients, and
depends of the degree to which symptoms are evident. Some of the commonly applied
treatment options include detoxification, inpatient rehabilitation, supportive housing,
psychotherapy and self help groups. The most important hurdle that dual diagnosis patients
pass through is detoxification. As compared to outpatient detoxification, inpatient
detoxification is more effective in treating patients. An individual suffering from a dependent
pattern of substance abuse and experiencing any major mental illness such as depression and
anxiety might benefit largely from the inpatient rehabilitation centers. Supportive houses and
self-help groups have also been proven to be effective in helping patients come out of the
feelings of isolation and frustrations (Stuyt 2015).
Vaz and Crockford (2017) reported on dual diagnosis and stated that the frequent co-
occurrence of psychiatric disorders and substance use has become a focus of concern among
researchers, clinicians, and public policy makers. Beyond the usual occurrence of the dual
diagnosis phenomena, much focus has been given to understand the particular patterns of
dual diagnosis and the urgent necessity to engage in the development of specialized programs

5
RESEARCH PROPOSAL
addressing dual diagnosis patient’s needs. Understanding the needs of persons and coming up
with a proper response against the highlighted needs serves as a significant public health
issue. Exacerbation of the mental illness acts as the most severe impact of substance abuse in
a direct or indirect manner. Some other complications include increased aggression, risky
behavior and increased chances of suicide. Further, substance abuse together with a mental
illness might be associated with physical comorbidities such as diabetes, nutritional
insufficiencies, cardiovascular problems and poor health conditions overall (Mcnelis 2015).
The proposed research is an attempt to review the present scope of dual diagnosis
treatment improvement aligned with the needs identified of the patients diagnosed with such
a condition. The present paper outlines a research that is to be conducted for understanding
the scope of improvement in dual diagnosis treatment approaches that are comprehensive.
The research proposal paper outlines the background of the study in an appropriate manner to
set the foundation for research. The aims and objectives of the proposed research are
articulated suitably. A rich literature review is put forward to highlight the gap existing in
current literature on the concerned topic. A methodology is proposed in this regard that gives
a detail of how the study would be conducted applying suitable research frameworks and
designs.
Background of the study
Individuals with dual diagnosis are often found to be exhibiting complex needs that
encompass physical support and social empowerment. The variety of needs that the patients
present influence the need of bringing reforms in treatment approaches. According to Petrakis
et al. (2018) apart from mental health issues and addiction, persons with dual diagnosis face a
number of other problems, such as housing problems, judicial problem, social isolation,
poverty and poor physical health. As a result of this, there is a strong likelihood of facing
major challenges by the healthcare professionals while working with patients with dual

6
RESEARCH PROPOSAL
diagnosis. Similarly, patients with dual diagnosis face a number of key challenges in
accessing treatment. At present, a multidimensional and integrated treatment approach is
considered for to be more than sufficient than a sequential treatment approach or a parallel
treatment approach. In such programs, the emphasis is given to both psychiatric problems as
well as substance abuse problems. Further, the focus of such integrated treatment options, in
alignment with the updated trends in addiction and mental health care policy, is gradually
shifting towards provision of support to achieve personal recovery (De Ruysscher, Vanheule
and Vandevelde 2017). Such a shift is witnesses against the previous trend of providing
symptoms based cure. Stabilization of patients is the prime focus in such a case. The chief
factors in an effective delivery of integrated system include treatment delivery in different
stages, assertive outreach, motivational approaches and provision for social support.
Connolly (2018) pointed out that modification in treatment approaches have emerged
against the fact that treatment of such patients leads to high economic costs for the healthcare
domain. Greater health burden, poor self care and exacerbation of the mental illness conspire
together to lead to an overpowering augmentation in the use of health services. The high
population of individuals with dual diagnosis leads to rapid utilization of healthcare resources
and leads to a decrease in the capability and capacity of services to coordinate treatment
options. The developments that have recently surfaced towards integrated treatment options
lead to a vast range of treatment modalities. Such modalities range from pharmacological
treatment and specialized therapeutic communities to self-help groups (Tirado-Munoz et al.
2018). Recent literature however point out that there are a number of treatment barriers that
hamper the process of care giving for patients with dual diagnosis. These barriers are related
to both structural factors such as financial constraints, organizational aspects, exclusion from
care services, and to the patient’s personal features such as cultural beliefs, motivation and
encouragement for treatment and self-stigma. In this regard Carra et al. (2015) stated that

7
RESEARCH PROPOSAL
such challenges lead to high rates of patient dropout, loss of focus on social context in
integrated services, and lack of emphasis on reducing the symptoms of the conditions.
Sterling and Hinman (2011) have highlighted the need of having an integrated
approach in treating substance abuse problems and severe mental illnesses. The researchers
attempted to answer there is an increased need of an integrated approach needed for dual
diagnosis treatment. Despite there has been much research put into the subject, integrated
support has not been made extensively accessible to clients. The reason for this are the
barriers that arise while treatment is bring delivered. It has been suggested that no particular
form of integrated treatment has emerged to be more powerful and effective than others.
Effective integrated treatment is one where professionals work in collaboration with each
other to provide interventions that are bundled together. The consumers therefore receive
consistent care for treating the varied symptoms (Hesse 2009). The philosophy and approach
are seamless, and the involvement of separate teams is not there anymore. Integrated systems
must recognize that counseling for substance abuse and that for mental health conditions are
different at the core.
Kelly and Daley (2013) in this regard mentioned that those who deliver care and those
who receive care are equally vulnerable to face challenges in the course of treatment.
Chances are high that patients might shift between services that focus on any one of the
treatment option for substance abuse or mental illness. Uncoordinated and fragmented care
services are the source of service gap for those suffering from co-occurring disorders.
Integrated services, when provided appropriately, would allow for improved health on an
overall basis. Further, such a form of service can ameliorate the impact of the disorders on
society at large. Through helping patients gain an improved quality of life, health care
providers can considerably decrease some of the costly and sinister societal concerns such as
domestic violence and HIV/AIDS (Mueser and Gingerich 2013).

8
RESEARCH PROPOSAL
Rationale of the study
Recent research has pointed out that integrated treatment services for patients
suffering from mental illness and substance abuse disorder lays the provision for treating
patients having severe but low prevalence mental health disorder. This implies that dual
diagnosis clients who have high rate of occurrence of mental health disorders are subjected to
unsatisfactory treatment services. As a result of this, the varied needs of the clients are
frequently unmet (Green et al. 2015). There has been a lack of studies that have undertaken a
thorough investigation of the views and experiences of patients with dual diagnosis with high
prevalence mental health needs for ensuring that the provision for treatment services are
adequate for meeting their needs. It is noteworthy that research is carried out for documenting
the different service needs of the patients suffering from high rate of occurrence of mental
health disorder and substance abuse (Ezquiaga et al., 2017).
The rationale is that based on the findings of such research redesigning of the present
models of treatment and care can be considered. Through an improved and evolved service
system one can hope that the specific needs of the patients can be met adequately within a
stipulated time. Reforms in service delivery process entail strong evidences that emerge from
the viewpoints of the service users. Information gained from the service users would form the
basis for addressing the needs as a whole, thereby resolving interdependence of issues and
alleviating the effect brought about by unresolved problems (Sinha, Garg and Prakash
20018). The best way to consider changes in service and treatment delivery is to bring into
limelight the perspectives and suggestions of those who are using it.
Aims and objectives
The proposed research is based on the context explained above in relation to
integrated treatment for dual diagnosis patients with mental disorders and substance abuse
disorder. The focus would be on dual diagnosis of substance abuse disorder including alcohol

9
RESEARCH PROPOSAL
abuse and drugs abuse, and depressive disorder and anxiety disorder. The research question
that would be the focus of the proposed study is as follows-
“What are the views of service users in relation to improvement of services for individuals
with dual diagnosis?”
The aim of the study would be to carry out a qualitative study to understand the
perspectives and opinions of service users in relation to the treatment provided to them for
dual diagnosis. The objectives of the research would be as follows-
 To understand the barriers faced by clients in receiving treatment for dual diagnosis of
mental health disorder and substance disorder
 To gain insight into the changes required in the treatment process delivered to patients
with for dual diagnosis of mental health disorder and substance disorder
 To identify the suggestions of service users for improving treatment services for dual
diagnosis of mental health disorder and substance disorder
Literature Review
According to Staiger et al. (2011), it is well known that the persons going through
alcohol or substance use (AOD) disorders are more susceptible have co-existing mental
health (MH) disorder like depressive syndromes or generalised anxiety (dual diagnosis).
According to Murthy and Chand (2012) mental health physicians frequently find the
treatment of the patients with dual diagnosis extremely challenging and difficulty. Although
nearly 50% of the patients suffering from severe mental illness are victims of substance use
and vice versa, the overall treatment aspect is compounded via the lack of complete clarity in
the psychological interventions, pharmacotherapy and setting of the treatment.

10
RESEARCH PROPOSAL
Pharmacological interventions and its drawbacks
The main pharmacological intervention used for treating patient with dual diagnosis is
the use of second generation antipsychotics. They are mostly preferred due to their negligible
side-effects especially in the domain of the extrapyramidal symptoms (EPS). Kelly et al.
(2012) s of the opinion that antipsychotics on the basis of theory dopaminergic action over
the mesocorticolimbic pathway significantly influence substance quite different from the
antipsychotic actions. Although second-generation antipsychotics are reported to be
beneficial in decreasing craving for the substances, there are differences in their produced
anti-craving effects between different medications (Van Dorn, Volavka and Johnson 2012).
This different in response is mainly due to difference among person to person arising out of
difference in the rate of occupancy of the D2 receptors and Clozapine receptors (Finn,
Viveros and Marco 2012). However, there are no significant researches in the domain of how
this knowledge about difference in expression of the D2 receptors is utilized while
prescribing clozapine among the substance abuse individuals in order to reduce the rate of
side-effects while promoting faster recovery.
Non-pharmacological interventions and its drawbacks
Under numerous contemporary settings of treatment, the mental health and substance
use services are procured in a separate manner. Therefore patients with dual diagnosis are
asked to get treated with in one system for one type of disorder and then referred to anther
system for another type of disorder (Baigent 2012). Sometimes two different sets of experts
for example mental health and the substance abuse experts evaluate such dual diagnosis
patients independently. Baigent (2012)is of the opinion that such models delay the overall
process of initiation of the accurate interventions and at the same time increase the overall
burden of the healthcare resources. On contrary, multidisciplinary “integrated treatment
approach” has same healthcare professionals working under one setting to procure both

11
RESEARCH PROPOSAL
mental health along with substance use interventions. Such interventions are mostly tailor
made for patients with dual diagnosis. This type of integrated treatment approach employs the
application of medicines for both mental health and substance use along with co-ordinated
psychotherapy and psychological treatments for mental health illness and substance use
matching with the motivation of the patients. However, Morrens et al. (2011) highlighted that
under an integrated set-up there at times occurs lack of individualized plan. Morrens et al.
(2011) also highlighted that under integrated setup there occurs delay in response during the
crises. The reason behind this is lack of adequate manpower under the integrated step-up high
rate of work-pressure which delays individualised attention.
Other important non-pharmacological interventions include cognitive behavioural
therapy and motivational therapy. Cognitive behavioural therapy (CBT) denotes one of the
popular therapeutic approaches that can be effectively applied to a variety of different
psychological problems (Murthy and Chand 2012). The meta-analysis conducted by
Hofmann et al. (2012) highlighted that CBT is extremely beneficial for anxiety disorders,
somatoform disorders, bulimia, anger control problems and other general stress related issues.
However, Ehde, Dillworth and Turner (2014) is of the opinion that under an integrated step
for the treatment of the patients dual diagnosis, it is seen that CBT therapy is applied as a
whole to a mass of patients with substance use disorder and suffering from mental illness like
schizophrenia, major psychotic disorders, severe depression, bipolar disorders, eating
disorders, anxiety disorders, personality disorders, aggression, anger, general stress and
criminal behaviours. Such that the outcome is not same with every patients and thereby
causing a delay in cure process among the patients whose mental health complications are not
compatible with the approach of the CBT. Cash (2012) is of the opinion that the majority of
the service provides for the dual diagnosis, lacks the ability to adapt themselves properly with

12
RESEARCH PROPOSAL
the individual circumstances with the clients and thereby leading to the procurement of the
therapy plan in a generalized approach in spite of claiming to provide a bespoke therapy plan.
Lack of personalised approach
In the domain of lack of bespoke approach towards the treatment of the patients with
dual diagnosis is further highlighted by Elwyn et al. (2014). Elwyn et al. (2014) is o the
opinion that there lacks significant gaps in the proper education among the service givers
towards procuring patient centred care and thereby generation increase in the length of
hospital stay among the patients with dual diagnosis and delay in proper cure. Elwyn et al.
(2014) stated that procurement of the patient centred care mainly demands different
approaches, which varies accordingly with the clinical situations. Elwyn et al. (2014)
emphasized over the motivational interviewing along with shared decision making to procure
appropriate and well-described methods to successfully accomplish patient-centred care
under the context of situations where significant medical evidences supports specific
behavioural changes and the best suited actions is solely dependent on the patients
preferences. However, numerous clinical consultations may demand elements of both the
approaches (Elwyn et al. 2014).
Stigmatization of the patients with dual diagnosis
Generation According to the research conducted by Van Boekel et al. (2013),
healthcare professionals are important in the proper identifications and accessibility of the
treatment for the people suffering from substance use disorders. However, the attitudes of the
healthcare professionals nurture negative attitudes towards the patients with substance use
disorders. This contributes towards the generation of suboptimal care for these patients along
with delay in the overall outcomes. Van Boekel et al. (2013) highlighted that perceived
violence, manipulation along with poor motivation are the main impending factors towards
the comprehensive healthcare delivery towards patients. Negative attitudes of the healthcare

13
RESEARCH PROPOSAL
professional destroy the feelings of the patients towards empowerment and successful
outcomes of the treatment. Healthcare professionals are also less involved and mostly prefer
more task-oriented approach in procuring healthcare to the patients with substance abuse and
this result in reduction in the overall personal engagement along with diminished empathy
(Van Boekel et al. 2013). Van Boekel et al. (2013) recommended that proper building and
maintaining relationships with the client along with addressing the complex mental health
issues of the person beyond illness would be helpful in managing the situations in an
effective manner and thereby helping in the fast disease recovery.
Research Gap
Thus from the above review of literature it can be easily highlighted that the majority
of the research that have been conducted over the interventions of the people with dual
diagnosis is mainly concentrated over the side-effects of the treatments and lacks of the
personalised approach of the treatment. All these pitfalls in the treatment plan for the patients
with dual diagnosis are mainly drawn over the perspective of the service providers or the
healthcare professionals. There are no significant discussion and research plan done from the
perspectives of the of the service users. One study conducted by Benaiges, Prat and Adan
(2012) mainly highlights how the lack of proper treatment for the patients with the dual
diagnosis affects the quality of the life of the service users. Moreover, that study was based
on a quantitative approach and is biased as it is only composed of male participants. Brett et
al. (2014) is of the opinion that the recording of the responses of the service users is the
principal way towards the proper accomplishments of the successful generation of an
effective therapy plan. Brett et al. (2014) further stated that since the service users are in the
direct representatives towards the successful outcomes of the therapy plan, their views and
the subsequent recommendation will help in the generation of effective personalized
approach for the proper treatment of the patients with dual diagnosis.

14
RESEARCH PROPOSAL
Methodology
According to Bernard (2011) the research mainly encompass the methodologies
which will be used in order to frame the overall process of research conduction while
maintaining proper focus over the research gap. The selection of proper methods mostly
depends on the aims and objectives of the research along with the appropriate selection of the
methodology which in turn will assist in deducing proper findings of the research.
Research philosophy
As opined by Bergh and Ketchen (2011), there are different types of research
philosophies like interpretivism, positivism and realism. This research will follow positivism
research philosophy. Berh and Ketchen (2011) stated that positivism research philosophy is
appropriate for qualitative research approach and assists in explaining the data in a scientific
manner along with the logical data representation.
Research approach
As opined by Crowther and Lancaster (2012), research approach can be subdivided
into two different types and this includes deductive and inductive research approach. In this
research, the author will use deductive research approach for formulating the hypothesis of
theoretical framework. The proper framing of the hypothesis will help in the establishment of
the relationships between the research objectives.
Research design
According to Ellis and Levy (2012), there are different types of research design like
explanatory, exploratory and descriptive style research design. In this research, author will
employ descriptive style research design. This particular research design will help the
researcher to comprehensively describe the cause and effect relationships generated in the
subsequent themes. With this research design, the researcher will generalize the overall

15
RESEARCH PROPOSAL
presentation of the research and thus evaluating the research problems. In this study, the
researcher will make use semi-structured interview with open-ended questionnaire that will
be developed specifically by the author after effective review of literature. The research
design will enable authentic validation of the information while maintaining the clarity of the
research (Leedy and Ormrod 2012).
Data Collection
According to Truscott et al. (2012), data collection is an integral part of the research
as it helps in proper analysis of the research topic. Nature of data collection is of two types,
quantitative data collection and qualitative data collection. Here the researcher will employ
qualitative mode of data collection. Miles, Huberman and Saldana have opined that
qualitative mode of data collection does not employ the use of statistical methods to quantify
the results. It progress the research under natural settings with an initiative to interpret the
process in term of inherent meaning which people bring to it (Sandelowski 2000). There are
various ways of collecting data in qualitative research in order to capture multiple realities
and thus obtaining an in-depth analysis of human experience. Some of the important mode of
data collection procedure for qualitative research is interviews focus groups and observations.
In this research, the author will employ semi-structured interviews directed towards 10
individuals of dual diagnosis who are the service users of mental health and substance abuse.
According to Galletta (2013), semi-structured interview is the most common method
employed in social science and nursing research. Semi-structured interview is different from
structured interview. Structured interview are mostly based on close ended questions which
restricts the interviewee from diverting out of the topic. Semi-structured interview is based on
open-ended questionnaire which provides avenues to create fresh new ideas during interview
sessions. The interviewer conducting a semi-structured interview has a proper framework of
specific themes that are required to be explored. Semi-structured interview also enables the

16
RESEARCH PROPOSAL
respondents the freedom to express their views in their own terms and thereby helping the
researcher to generate comparable data. Thus via selecting semi-structured interview as a
mode of qualitative data collection will help the researcher to analyse the experience of
individuals with dual diagnosis about the available service for mental health and substance
abuse. In this research, the interview will be guided through an indicative schedule through 3
open-ended questions (questions provided below) and the duration of the interview will be 30
to 45 minutes. The entire response of each participant will be recorded digitally and some
portion of the verbal communication will also be documented by interviewer manually
(Kallio et al. 2016). The digitally recorded audio will be transcribed after the interview
process via a transcriptionist and the generated transcript will be cross checked by the audio
and respective respondents in order to maintain clarity of the research.
Interview Question
1. What is your experience in availing service for mental health and substance abuse
2. What are your views in accessing barriers of the treatment?
3. How services can be improve overall to meet their needs
Sampling and Participants selection
The researcher here will employ random and stratified sampling technique. According
to Berg and Ketchen (2011), this will help the researcher to select the prospective
respondents from particular focus group. The main selection criteria that will be followed
during selecting the main participants for the focus group interview include
1. Age above 18 years
2. Suffering from dual diagnosis for the past 1 year

17
RESEARCH PROPOSAL
3. Dual diagnosis will mainly include substance abuse (alcohol or substance use
disorder) and mental health problems (depressive disorders and/or generalised anxiety)
4. Service users of both mental health and substance abuse rehabilitation
Data analysis
The researcher here will utilise thematic data analysis. According to Clarke and Braun
(2014), the strategy of thematic analysis is mainly employed for the majority of the
qualitative research without providing notable highlight about how the entire process helps to
decrease the data into workable theme and emerging summary. In other words, it can be said
that the process of thematic analysis is a method for identification, analysis, reporting of
generated themes from collected data. It is a form of descriptive method which reduces the
information into meaningful themes. It is frequently used in qualitative data analysis method
for its flexibility in accommodating vast majority of research questions and research topics.
The main steps that will be used for the thematic analysis of data include compiling,
disassembling, reassembling, interpreting and concluding.
Ethical consideration
The first ethical consideration that should be taken into account is getting approval
from the Nursing and Midwifery Council local ethics committee to access the service users of
dual diagnosis. After getting the approval, an official letter will be sent to the co-ordinator of
the service provider of dual diagnosis seeking permission to contact with the potential service
users. The co-ordinator of the overall program will be then asked to circulate emails to each
of the service users (more than a year) stating the set-up of the research along with rationale
and scope of the study. The contact details of the concerned researcher will be included at the
end of email so that the willing participants can ask questions to research directly about
further information in the overall process of the study. The interested candidates will then be

18
RESEARCH PROPOSAL
asked to reply to the mail directly. Interested candidates will then have a face-to-face
conversation with the researcher about the further process and rationale of the research. After
that, if they are satisfied and are willing to participate, they will be asked to sign a consent
form. No participants will be forced to participate in the interview and will be given full
liberty to leave the process at any point of time in the research, be it after, within and before
the conduction of the interview. They are not required to cite any prior justification for their
sudden withdrawal. They will also be informed that if they are not willing to participate in the
interview process, it will not impact on their overall therapy process. The time schedule and
venue of the study will solely depend as per the convenience and availability of the
participants. The research is unlikely to cause any form of psychological distress. However,
the researcher will also make sure that the associated risk of psychological distress will be
negligible during the study. If any of the respondents becomes distressed emotionally, during
the process of interview, the interview will be discontinued immediately. After the end of the
interview, the participants will be provided ample time for discusses any further queries
associated with the interview process. Moreover, the official transcript will sent to each of the
respondents and will only be used for the research after their final approval of typed
transcript (Scott and Garner 2013).
In order to maintain the confidentiality of the research process, the researcher will not
disclose the names of the interviewee in the final interview transcript and any pseudo names
will be used to discriminate between one individual with others. The signed consent obtained
from the participants before initiation of the interview process will be stored separately in
locked shelves and the written records of the interview will be locked separately in another
cabinet. All the materials will be kept secured for 10 years after the interview conduction. All
the audio recordings along with the transcript will be encrypted in the personal computers of

19
RESEARCH PROPOSAL
the respective participants and the same will be erases completely following the final
transcription (Sandelowski 2000).
Conclusion
Thus from the above discussion, it can be concluded that this qualitative research will
follow thematic analysis with deductive research approach, positivism research philosophy
and descriptive style research design. Under the thematic analysis, this research will employ
the weapon of semi-structured interview and will perform thematic data analysis.
Time Plan of the research
Grant Chart
Task Week
1
Week
2
Week
3
Week
4
Week
5
Week 6 Week
7
Week
8
Week 9
Review of literature 
Gaining ethical
approval

Selection of the
participants

Conducting
interview

Transcript
preparation

Generation of
themes


20
RESEARCH PROPOSAL
Analysis of the
themes

Conclusion 
Recommendation  
Final layout of the
assignment


21
RESEARCH PROPOSAL
References
Alzayyat, A. and Al‐Gamal, E., 2014. A review of the literature regarding stress among
nursing students during their clinical education. International Nursing Review, 61(3), pp.406-
415.
Baigent, M. (2012). Managing patients with dual diagnosis in psychiatric practice. Current
opinion in psychiatry, 25(3), 201-205.
Benaiges, I., Prat, G. and Adan, A., 2012. Health-related quality of life in patients with dual
diagnosis: clinical correlates. Health and quality of life outcomes, 10(1), p.106.
Bergh, D., and Ketchen, D. J., 2011. Research methodology in Strategy and Management, 1st
ed. Bingley: Emerald Group Publishing Ltd
Bernard, H. R. (2011) Research Methods in Anthropology: Qualitative and Quantitative
Approaches. 5th ed. Plymouth: London. Alta Mira Press.
Brett, J., Staniszewska, S., Mockford, C., Herron-Marx, S., Hughes, J., Tysall, C. and
Suleman, R., 2014. A systematic review of the impact of patient and public involvement on
service users, researchers and communities. The Patient-Patient-Centered Outcomes
Research, 7(4), pp.387-395.
Carrà, G., Crocamo, C., Borrelli, P., Popa, I., Ornaghi, A., Montomoli, C. and Clerici, M.,
2015. Correlates of dependence and treatment for substance use among people with comorbid
severe mental and substance use disorders: Findings from the “Psychiatric and Addictive
Dual Disorder in Italy (PADDI)” Study. Comprehensive psychiatry, 58, pp.152-159.
Cash, T.F., 2012. Cognitive-behavioral perspectives on body image. In Encyclopedia of body
image and human appearance (pp. 334-342).

22
RESEARCH PROPOSAL
Castleberry, A. and Nolen, A., 2018. Thematic analysis of qualitative research data: Is it as
easy as it sounds?. Currents in Pharmacy Teaching and Learning.
Chernomas, W.M. and Shapiro, C., 2013. Stress, depression, and anxiety among
undergraduate nursing students. International Journal of Nursing Education
Scholarship, 10(1), pp.255-266.
Clarke, V. and Braun, V., 2014. Thematic analysis. In Encyclopedia of critical
psychology (pp. 1947-1952). Springer New York.
Connolly, J., 2018. Developing a comprehensive, integrated and contemporary recovery
oriented dual diagnosis service, within the environment of primary and continuing care in
Cork, Ireland (Doctoral dissertation, Dublin City University).
Crowther, D., and Lancaster, G., 2012. Research Methods, 2nd ed. London: Routledge.
De Ruysscher, C., Vanheule, S. and Vandevelde, S., 2017. ‘A place to be (me)’: a qualitative
study on an alternative approach to treatment for persons with dual diagnosis. Drugs:
Education, Prevention and Policy, pp.1-10.
de Waal, M.M., Christ, C., Dekker, J.J., Kikkert, M.J., Lommerse, N.M., van den Brink, W.
and Goudriaan, A.E., 2018. Factors associated with victimization in dual diagnosis
patients. Journal of substance abuse treatment, 84, pp.68-77.
Ehde, D.M., Dillworth, T.M. and Turner, J.A., 2014. Cognitive-behavioral therapy for
individuals with chronic pain: efficacy, innovations, and directions for research. American
Psychologist, 69(2), p.153.

23
RESEARCH PROPOSAL
Ellis, T., and Levy, Y., 2012. ‘Towards a guide for novice researchers on research
methodology: Review and proposed methods’, Issues in Informing Science and Information
Technology, 6, 323-337.
Elwyn, G., Dehlendorf, C., Epstein, R.M., Marrin, K., White, J. and Frosch, D.L., 2014.
Shared decision making and motivational interviewing: achieving patient-centered care
across the spectrum of health care problems. The Annals of Family Medicine, 12(3), pp.270-
275.
Ezquiaga, I., Vega, Z.G., Rossi, P., Fonseca, F., Tamarit, C., Castillo, C., Castro, I. and
Torrens, M., 2017. Dual diagnosis: On the way to an integrated treatment model?. European
Psychiatry, 41, pp.S134-S135.
Finn, D. P., Viveros, M. P., and Marco, E. M. 2012. The endocannabinoid system and
emotional processing: pathophysiology and therapeutic potential. Journal of
Psychopharmacology, 26(1), 3-6.
Galletta, A., 2013. Mastering the semi-structured interview and beyond: From research
design to analysis and publication. NYU press.
Green, C.A., Yarborough, M.T., Polen, M.R., Janoff, S.L. and Yarborough, B.J.H., 2015.
Dual recovery among people with serious mental illnesses and substance problems: a
qualitative analysis. Journal of dual diagnosis, 11(1), pp.33-41.
Henderson, A., Cooke, M., Creedy, D.K. and Walker, R., 2012. Nursing students' perceptions
of learning in practice environments: a review. Nurse education today, 32(3), pp.299-302.
Hesse, M., 2009. Integrated psychological treatment for substance use and co-morbid anxiety
or depression vs. treatment for substance use alone. A systematic review of the published
literature. BMC psychiatry, 9(1), p.6.

24
RESEARCH PROPOSAL
Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T. and Fang, A., 2012. The efficacy of
cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and
research, 36(5), pp.427-440.
Kallio, H., Pietilä, A.M., Johnson, M. and Kangasniemi, M., 2016. Systematic
methodological review: developing a framework for a qualitative semi‐structured interview
guide. Journal of advanced nursing, 72(12), pp.2954-2965.
Kelly, T. M., Daley, D. C., and Douaihy, A. B. 2012. Treatment of substance abusing patients
with comorbid psychiatric disorders. Addictive Behaviors, 37(1), 11-24.
Kelly, T.M. and Daley, D.C., 2013. Integrated treatment of substance use and psychiatric
disorders. Social work in public health, 28(3-4), pp.388-406.
Leedy, P. D., and Ormrod, J., 2012. Practical Research: Planning and Design, 2nd ed. New
Delhi: Person Education
Lehman, A.F. and Dixon, L. eds., 2016. Double jeopardy: Chronic mental illness and
substance use disorders. Routledge.
McGovern, M.P., Lambert-Harris, C., Gotham, H.J., Claus, R.E. and Xie, H., 2014. Dual
diagnosis capability in mental health and addiction treatment services: an assessment of
programs across multiple state systems. Administration and Policy in Mental Health and
Mental Health Services Research, 41(2), pp.205-214.
Mcnelis, T., 2015. The Dual Diagnosis Treatment Team. Journal of Intellectual Disability
Research, 59, p.63.
Miles, M.B., Huberman, A.M. and Saldana, J., 2013. Qualitative data analysis. Sage.

25
RESEARCH PROPOSAL
Morrens, M., Dewilde, B., Sabbe, B., Dom, G., De Cuyper, R., & Moggi, F. (2011).
Treatment outcomes of an integrated residential programme for patients with schizophrenia
and substance use disorder. European addiction research, 17(3), 154-163.
Mueser, K.T. and Gingerich, S., 2013. Treatment of co-occurring psychotic and substance
use disorders. Social work in public health, 28(3-4), pp.424-439.
Murthy, P., and Chand, P. 2012. Treatment of dual diagnosis disorders. Current Opinion in
Psychiatry, 25(3), 194-200.
Ogloff, J.R., Talevski, D., Lemphers, A., Wood, M. and Simmons, M., 2015. Co-occurring
mental illness, substance use disorders, and antisocial personality disorder among clients of
forensic mental health services. Psychiatric rehabilitation journal, 38(1), p.16.
Petrakis, M., Robinson, R., Myers, K., Kroes, S. and O'Connor, S., 2018. Dual diagnosis
competencies: A systematic review of staff training literature. Addictive Behaviors
Reports, 7, pp.53-57.
Pulido‐Martos, M., Augusto‐Landa, J. M. and Lopez‐Zafra, E., 2012. Sources of stress in
nursing students: a systematic review of quantitative studies. International Nursing
Review, 59(1), 15-25.
Reeve, K.L., Shumaker, C.J., Yearwood, E.L., Crowell, N.A. and Riley, J.B., 2013. Perceived
stress and social support in undergraduate nursing students' educational experiences. Nurse
Education Today, 33(4), pp.419-424.
Rocco, P., Manera, R. and Bellio, G., 2017. The Diagnostic Stability in Dual Diagnosis Study
on a Sample of Patients with Opiate Addiction. Journal of Health Science, 5, pp.18-24.

26
RESEARCH PROPOSAL
Sandelowski, M., 2000. Focus on research methods-whatever happened to qualitative
description?. Research in nursing and health, 23(4), pp.334-340.
Sarath Rathnayake, R.N., 2016. Depression, anxiety and stress among undergraduate nursing
students in a public university in Sri Lanka. International Journal of Caring Sciences, 9(3),
p.1020.
Scott, G. and Garner, R., 2013. Doing qualitative research: designs, methods, and
techniques. Upper Saddle River: Pearson.
Silverman, D., 2015. Interpreting qualitative data. Sage.
Sinha, P., Garg, A. and Prakash, O., 2018. Integrated Treatment For Dual Diagnosis: The
Journey So Far. Malaysian Journal of Psychiatry, 26(1).
Staiger, P. K., Thomas, A. C., Ricciardelli, L. A., Mccabe, M. P., Cross, W., and Young, G.
2011. Improving services for individuals with a dual diagnosis: A qualitative study reporting
on the views of service users. Addiction research & theory, 19(1), 47-55.
Sterling, S., Chi, F. and Hinman, A., 2011. Integrating care for people with co-occurring
alcohol and other drug, medical, and mental health conditions. Alcohol Research &
Health, 33(4), p.338.
Stuyt, E.B., 2015. Enforced abstinence from tobacco during in‐patient dual‐diagnosis
treatment improves substance abuse treatment outcomes in smokers. The American journal
on addictions, 24(3), pp.252-257.
Tirado-Munoz, J., Farre, A., Mestre-Pinto, J., Szerman, N. and Torrens, M., 2018. Dual
diagnosis in Depression: treatment recommendations. Adicciones, 30(1).