Drug and alcohol users have been suggested to face disproportionate exclusion from mental health services, but data on any such exclusion are not readily available. This study examined the clinical records of those excluded from an NHS Talking Therapies service due to drug or alcohol use, focusing on (1) quantitative levels of alcohol consumption, and (2) the rationales documented by clinicians for excluding these individuals. Our results suggest that over half (57%) of those excluded due to alcohol use were consuming below the 15-unit daily threshold recommended for signposting to specialist alcohol assessment. Clinicians cited various rationales for exclusion, including the potential for poor treatment outcomes and health risks associated with concurrent use. Due to being based on a single service, these findings may be limited in their generalisability, but they offer an initial signal that there is potential over-exclusion of some alcohol users from NHS Talking Therapies, and that rationales for exclusion may not consistently align with best practice principles. We discuss implications for NHS Talking Therapies clinicians, and for the development of future clinical guidance.

1. (1) To understand how different levels of drug or alcohol use may affect the outcomes of psychological therapy.

2. (2) To learn why individuals with drug or alcohol use experience exclusion from mental health services.

3. (3) To examine how clinical practice within an NHS Talking Therapies service aligns with best practice principles.

4. (4) To explore skills and clinical principles that can lead to optimal treatment planning for these individuals.

5. (5) To explore how integrated working between NHS Talking Therapies and local drug and alcohol services can enhance service-user experiences.