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Background: Drug treatment clients are significantly more likely to remain in treatment if ancillary life issues and complex needs are addressed. Aim: to document and analyse the complex needs (¿complex vulnerabilities¿) of people experiencing both problems with drug dependence and common mental health problems, with a particular focus on barriers and incentives to drug treatment. Method: A qualitative interview-based study of 77 participants in four sites (three metropolitan, one regional) in Australia. Results: Complex vulnerabilities were deeply embedded in participants¿ lives and unlikely to be quickly resolved. Poor housing, criminal justice issues and the experience of poverty or debt affected participants¿ ability to secure basic needs, and their ability to participate in drug or mental health treatment. Difficulties in finding assistance for complex vulnerabilities especially at times of crisis, were reported by many participants. Conclusions: There is an urgent need to reform the health system to better meet the needs of this group and ensure a ¿no wrong door¿ policy. The resilience demonstrated by participants in managing complex issues should be acknowledged, although the deleterious effect of complex vulnerabilities on treatment participation and outcomes should be recognised.