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Introduction
Historically, people with co-occurring mental health and substance use problems have typically fallen between parallel service systems. Today, the majority of literature on the care of persons with co-occurring disorders recommends a comprehensive and integrated approach (Davidson et al., 2008; Mueser and Gingerich, 2013). Based on this growing literature, Drake et al. (2001) and Davidson et al. (2008) argue that it requires such a multi-dimensional approach for care to be tailored to meet the complex and multi-dimensional needs of persons with comorbid problems. Persons with co-occurring disorders require numerous specialized resources (e.g. specialized health services, social services, employment and housing programs, etc.) and make intensive use of these services (Brousselle et al., 2010; Donald et al., 2005; Kedote and Champagne, 2008; Mueser and Gingerich, 2013; Roberts, 2010; Rush et al., 2008).
As a result of these complexities, persons with co-occurring conditions have at times been referred to as posing “double trouble”. Drawing on their experiences in the recovery movement, Davidson et al. (2008) propose instead to use the term “dual recovery”. This term acknowledges that people with mental health and addiction problems are first and foremost people rather than their diagnoses or disorders, and emphasizes that the person with these experiences has his or her own form of expertise related to both in living through and in recovering from mental illnesses and addictions. It is not up to practitioners to “recover” people, but rather to provide support for the person's own efforts and to assist with establishing other preconditions of recovery (e.g. a supportive environment). It is, however, up to the person to become active and empowered and to take control over his or her situation (Roberts and Boardman, 2014). This means that it is not the person with co-occurring mental health and substance use problems who presents a challenge to the system of care, but the person who confronts the challenges of having to live with and recover from mental health and substance use problems. A recovery orientation in mental health and addiction care in this way involves considering recovery as both a personal process (e.g. Hydén, 1995; Deegan, 1988) and a social process (Borg and Davidson, 2007; Topor et al., 2011; Borg et al., 2013).
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