In Italy, dual diagnosis issues are affected by distinctive historical pathways. Since the end of the 1970s, the addiction field has been starved of psychiatric contribution, with the emphasis being on a pedagogical model of substance-related disorders and a bio-psycho-social model for mental health. As such, dual diagnosis treatment, service models, and research have only been developed in the last fifteen years. Substantial training needs with regard to dual diagnosis are identified in addiction and mental health professionals, and new graduate and undergraduate programs are required. Further research is needed as well as an evidence-based health policy from national and regional government.