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Society's response to alcohol and drug problems must continually evolve. The author expresses optimism about evaluation's ability to guide change from the ground up through developing a culture of ongoing learning. It is argued that the alcohol and other drug treatment sector has a particular need for empowering professional development processes. The article describes the background to and personal experience of a new unit within a Graduate Diploma in Alcohol and Other Drug Studies course.This article is an edited version of a paper presented on 7 September 2007 at the conference of the Australasian Evaluation Society, 'Doing Evaluation Better', Melbourne. Bridget Roberts introduced the presentation by acknowledging the people of the Kulin nation, specifically the Wurundjeri (the first people to occupy the Melbourne area and the custodians of this land), including their elders past and present.

Health services are more effective if they are coordinated around the person, family or community. Frequently they operate in silos determined by diagnosis. Many people with mental health problems also have problems with alcohol and other drug (AOD) use, and vice versa. The coexistence of such problems has been variously termed 'dual diagnosis', 'co-occurring disorders' or 'comorbidity'. In recent decades attention has been drawn to the problem of fragmented services for people considered to have a 'dual diagnosis'. A dual diagnosis discourse has developed around the proposition that there should be 'no wrong door' when people seek treatment or support. Services specialising in either mental health or drug and alcohol treatment should recognise assess and respond to co-occurring problems. Little research attention has been paid to the historical and cultural impediments to the 'no wrong door' approach. The thesis asks: Why did dual diagnosis discourse emerge? How did it evolve in the two specialist sectors? What are the implications for service users/consumers, services, professions and governments? How has the discourse played out in the context of an espoused vision of person-centred care, rather than care organised around disciplinary and service structures? The research, focusing on the State of Victoria since 1985, involved a qualitative exploration comprising six stages: a review of research literatures; collection and analysis of government policy documents; in-depth interviews with key informants, purposively selected to offer varied perspectives from the level of policy development and service leadership; feedback of findings to these informants for validation and further comment; synthesis of findings into papers for peer review; and final refinement of conclusions in the submitted thesis. I found that dual diagnosis discourse emerged in Victoria at a time of greater differentiation between services. Deinstitutionalisation was a part of this but further contributors were greater managerialism, the allocation of funds according to diagnosis, professional turf issues and a broadening of the scope of mental health and AOD strategies to encompass mild and moderate as well as severe conditions. 'Capacity-building' characterised the discourse and strategies through the 1990s and 2000s, entailing top down and bottom up change management that challenged over-specialisation and offered leadership, networks and a focus for achievement. The mental health and AOD sectors both made at best incremental progress towards a 'no wrong door' service culture. Still to be resolved are enduring therapeutic pessimism, particularly in the acute mental health sector, cultural clashes between sectors, and enduring social stigma. The thesis contributes to the body of qualitative research on the history and course of efforts to develop appropriate care for patients who are considered to have alcohol and drug problems and other mental health disorders. More broadly, the thesis illuminates the development and implications of a medical construct over time in a particular context. It adds to the evidence for improving quality control and interdisciplinary, intersectoral workforce development with a focus on patient strengths and recovery within an integrated health and social support system.

The historical and current status of Indigenous people needs careful consideration in designing evaluations of Indigenous-specific programs. In Australia, the evaluator operates in a context arising from past policies of discrimination against Indigenous people and limited current policy moves toward community control and self-determination. Evaluation guidelines and standards exist to provide direction and become particularly valuable in complex project conditions, such as the current evaluation. This paper reflects on guidelines of the Australasian Evaluation Society and standards of the American Evaluation Association (AEA) as they apply to the evaluation of Indigenous programs in Victoria, focusing on our recent experience in the evaluation of Indigenous specific alcohol and drug programs. Particular attention is given to the utility standards of the AEA, given the range of key stakeholders involved in the evaluation. We discuss the consistency of our approach with the utility standards and suggest areas where modification to the standards may be useful, drawing particularly on the modifications to the standards that have been put forward by the African Evaluation Association. In reflecting on the evaluation, we also identify areas for change in future projects involving Indigenous programs.

Purpose: The integration of health or social services is an enduring challenge and especially so in relation to people experiencing "dual diagnosis", the co-occurrence of mental health and substance use problems. The emergence of the "dual diagnosis" concept has highlighted the tension between specialist treatment for single problems and complex, individualised care. The purpose of this paper is to examine the evolving nature of dual diagnosis initiatives in an Australian state during recent decades. Design/methodology/approach: Interpretive, case study analysis of policy documents and key informant interviews (19) illuminates the experience of dual diagnosis initiatives. Findings: In the case of Victoria, dual diagnosis responsiveness has evolved slowly over the last 20 years, delayed by the inherent difficulty of practice change, a weak perception of need, interprofessional tensions and shortcomings in data collection, coordination and resources. Key enablers have been champions and leaders in policy, management and clinical practice, directive government policy and targeted funding. Achieving a wrap-around service system entails investment in interpersonal relationship-building and stigma reduction, as well as technical or structural changes. Originality/value: The paper presents a unique and independent view of a 20-year period and indicates progress in attitudinal change that merits wider acknowledgement and application to other settings throughout health and social care.

Purpose: The integration of health or social services is an enduring challenge and especially so in relation to people experiencing "dual diagnosis", the co-occurrence of mental health and substance use problems. The emergence of the "dual diagnosis" concept has highlighted the tension between specialist treatment for single problems and complex, individualised care. The purpose of this paper is to examine the evolving nature of dual diagnosis initiatives in an Australian state during recent decades. Design/methodology/approach: Interpretive, case study analysis of policy documents and key informant interviews (19) illuminates the experience of dual diagnosis initiatives. Findings: In the case of Victoria, dual diagnosis responsiveness has evolved slowly over the last 20 years, delayed by the inherent difficulty of practice change, a weak perception of need, interprofessional tensions and shortcomings in data collection, coordination and resources. Key enablers have been champions and leaders in policy, management and clinical practice, directive government policy and targeted funding. Achieving a wrap-around service system entails investment in interpersonal relationship-building and stigma reduction, as well as technical or structural changes. Originality/value: The paper presents a unique and independent view of a 20-year period and indicates progress in attitudinal change that merits wider acknowledgement and application to other settings throughout health and social care.

Although codes of conduct and ethics provide guidance, professionals have to exercise their own judgement in increasingly complex and demanding roles and work contexts when applying them to practice. At times, this can lead to conflict between personal, professional and interprofessional ethics due to the dynamics of the person-centred environment they function in. This interdisciplinary book draws on the perspectives of 40 authors from four continents to explore the dynamics of ethical dilemmas using theory, research and practice-based examples. Overall, the book will help to spearhead the debate about these ethical dilemmas, and ways of working with them, in an informed manner. It will make ideal reading for students, academics and professionals