With alcohol use disorder rising in England, evaluating the impact of interventions used in services is important. This evaluation was conducted in a third sector drug and alcohol service within South England. It aimed to explore the association of a structured cognitive behaviour therapy (CBT) group and engagement for service users in early recovery from alcohol use disorder, comparing outcomes with a previously unstructured psychosocial group. A mixed-methods approach compared the groups. Both groups lasted 12 sessions. Self-reported alcohol consumption, psychological health, physical health, and quality of life were measured using the Treatment Outcomes Profile (TOPs; Marsden et al., 2008). Quantitative data were analysed from 47 service users in the unstructured group and 43 in the structured CBT group. Qualitative analysis explored four service users’ feedback from the structured CBT group through interviews, using thematic analysis. Significantly more participants completed the structured CBT group (93.02% vs 74.47%). Structured group participants, on average, attended 50.97% of sessions, compared with 25.53% in the unstructured group. Mixed-model ANOVAs (repeated measures and between subjects) showed an improvement in psychological health, quality of life, and physical health regardless of the intervention type. Both groups also reduced alcohol consumption. Qualitative analysis identified two emerging themes, accessibility and a sense of belonging, alongside several subthemes. While both groups improved treatment outcomes, findings suggest a structured CBT group may be associated with more engagement and facilitate greater retention in treatment.

Key learning aims

1. (1) To understand how engagement and treatment outcomes differ between a structured CBT group and an unstructured psychosocial group in the treatment of alcohol use disorder.

2. (2) To identify potential mechanisms in a structured group which may influence engagement and treatment outcomes in the treatment of alcohol use disorder.

3. (3) To reflect on differing ways to measure effectiveness of a group in community drug and alcohol services.

Individuals with co-occurring mental health and substance use disorders present considerations often requiring interventions from multiple services. This paper describes the development and implementation of an integrated service pathway, emphasising collaborative processes and inter-professional relationships. The model, implemented in partnership between an NHS Talking Therapies service and a local substance use service, aimed to improve care coordination and service delivery for adults with co-occurring disorders. This paper provides a description of the pathway, outlining the challenges that prompted its development, the processes involved in its establishment, the roles and responsibilities of professionals, and the mechanisms for ensuring continuity of care. A small service evaluation, employing a mixed-methods approach, examined the outcomes of nine patients who engaged with the one-to-one integrated pathway within the first 10 months of its inception. The implementation of the model resulted in enhanced inter-service collaboration, with improved communication protocols and a shared understanding of service user needs. Clinicians reported that the reciprocal consultative approach facilitated knowledge exchange and skill development across teams. Initial outcome data from a small sample suggests positive trends in patient wellbeing and substance use, with seven of nine patients discharged in recovery. This model, characterised by a reciprocal consultation approach and an emphasis on inter-professional collaboration, demonstrates potential to improve the care for co-occurring mental health and substance use disorders. While the patient outcome data are limited by the small sample size, the findings offer insights for service re-design and future research.

Key learning aims

1. (1) To gain a clearer understanding of the development and implementation of an integrated care model for co-occurring mental health and substance use disorders.

2. (2) To recognise the impact of collaborative approaches on the professionals involved, including influences in communication protocols, knowledge exchange, and skill development across teams.

3. (3) To learn about the initial outcomes of the integrated care pathway and to recognise the potential for improving care in patients with co-occurring disorders.

Chemsex is a pattern of using specific drugs with the intent of enhancing the sexual experiences of men who have sex with men. Chemsex participation is often motivated by a desire for community connection or enhanced sexual pleasure. Many individuals who participate in chemsex can mitigate much of the associated risk and report limited, if any, harm. However, for some, chemsex can be problematic, precipitating or exacerbating mental health issues. Despite increasing amounts of research into chemsex, there is no consensus about how to best support people who participate in chemsex when they present for psychological therapies. In the absence of specific clinical guidelines, this paper explores the intersection of chemsex and mental health problems. Principles of affirming and non-stigmatising, assessment, formulation, and intervention strategies are discussed, and recommendations are made throughout. Drawing on contemporary evidence, we present cognitive behavioural approaches to supporting service users who participate in chemsex with anxiety, depression, and post-traumatic stress disorder. By enhancing cultural safety and tailoring existing evidence-based treatments, therapists can improve engagement and outcomes for individuals who engage in chemsex. We recommend an inclusive approach that champions service user choice, paired with a sensitive, sex-positive, and trauma-informed perspective. Therapists within Talking Therapy services are well placed to support service users who participate in chemsex and have co-occurring mental health difficulties.

Key learning aims

1. (1) To understand what chemsex is, what motivates chemsex participation, and the distribution of potential risks.

2. (2) To understand the intersection of sexuality, chemsex, and co-occurring mental health difficulties, including the role of pleasure, identity, shame and community.

3. (3) To identify the key barriers experienced by people who participate in chemsex when accessing mental health services, such as negative staff attitudes or fear of stigma.

4. (4) To explore cognitive behavioural approaches to working with people who participate in chemsex, and associated common mental health difficulties (anxiety, depression, and post-traumatic stress disorder).

5. (5) To identify practical strategies to engage service users who participate in chemsex.

Contemporary literature suggests that cognitive behavioural therapy (CBT) is an effective intervention for substance use (SU) and for psychosis. However, research investigating the effectiveness of CBT for SU in people with psychosis is sparse. This study used a single-case experimental design (SCED) to evaluate the outcomes of CBT for cocaine use in an individual with a history of psychosis. It was predicted that he would show reductions in substance use, urges and cravings, alongside improvements in broader psychosocial domains. After conducting a cognitive behavioural assessment, the client received CBT focused on psychoeducation, formulation, relapse prevention, relationships and sleep. Non-parametric tests were used to examine whether his scores changed significantly between the baseline and intervention phases. Progress was tracked using idiographic measures based on the client’s goals, including targets linked to SU and secondary lifestyle factors. Across therapy, statistically significant improvements were observed in the client’s self-reported urges to use drugs, feelings of emptiness, openness with his partner and sleep. Also, trends towards significant improvements were identified in his self-reported risk of SU, cocaine abstinence, cocaine cravings, connection with his partner and feelings of shame and loneliness. No significant differences were observed for his self-reported confidence or exercise. This case study offers tentative evidence that CBT is an effective intervention for SU in individuals with psychosis.

Key learning aims

1. (1) To understand the potential effectiveness of cognitive behavioural therapy for substance use in individuals with psychosis, specifically regarding cocaine use.

2. (2) To utilise single-case experimental designs and idiographic measures to robustly evaluate therapy outcomes in complex clinical presentations.

3. (3) To describe a cognitive behavioural approach that utilises longitudinal formulation and interventions targeting sleep and relationships, as well as substance-focused work to support recovery.

There is a growing evidence base for the treatment of gambling harms indicating that cognitive behavioural therapy (CBT) is an effective treatment. However, limitations in research methodology raise questions about the effective mechanisms of change. Existing research has been inconsistent in the measurement of change, and it is not clear whether markers of recovery identified by researchers represent the treatment goals that are most important to those recovering from gambling harm. This study aimed to clarify these areas using a single-case experimental design for treatment seekers accessing a CBT intervention. Recovery trajectories were observed for eight participants attending a group CBT programme, identifying changes in measures of wellbeing and gambling severity through baseline, treatment and follow-up phases. Each participant’s recovery journey was illustrated through weekly measures of perceived closeness to achieving their self-identified treatment goal as well as daily reports of urge severity and presence of gambling behaviour. Findings indicated that all participants viewed abstinence from gambling as their treatment goal. Unexpectedly, half of the sample had already achieved abstinence prior to attending the CBT programme, suggesting that additional factors, including initial contacts with the service contributed to reductions in gambling. This finding also indicated that for individuals recovering from gambling harm, achieving abstinence is not the end of their recovery. Most participants demonstrated improvements in wellbeing and gambling-related cognitions that could be attributed to the CBT programme, with those gambling at baseline showing improvements in gambling urges and behaviour following treatment. The study highlights the need for service-user perspectives in measurements of recovery. Implications for clinical practice and future research are discussed.

Key learning aims

1. (1) CBT has good efficacy for treatment of gambling harm, established in trials.

2. (2) Establishing outcomes for individuals receiving CBT in NHS practice is important.

3. (3) Existing studies do not always identify the outcomes that are important to service users.

4. (4) Single case research is a valuable tool to explore outcomes in practice.