There has been substantial recent renewed interest and investment to assess the therapeutic potential of psychedelic compounds in addiction disorders. This editorial discusses the available evidence from randomised trials and future research directions in the field, together with potential implications for patients, professionals and the wider addiction treatment system.

Natoli et al present a comprehensive higher level framework aligning dimensional personality pathology assessment with treatment delivery through a hierarchical model. Their approach integrates common therapeutic factors with trait-specific interventions, offering a promising pathway for clinical implementation. Despite strong evidence supporting the superiority of dimensional models and the field's shift towards dimensional classification, they remain largely unused in clinical practice after a decade, despite evidence of clinical utility and learnability. Although the authors’ framework demonstrates how dimensional approaches could work in practice, particularly through matching severity to treatment intensity and traits to specific interventions, healthcare systems require evidence of improved clinical outcomes before undertaking systemic change. Without controlled trials demonstrating enhanced treatment effectiveness, dimensional models risk remaining theoretically superior but practically unused. While healthcare systems remain tethered to categorical diagnostic approaches, the authors’ framework offers a practical pathway for implementing dimensional models – one that now requires testing in real-world settings.

‘Each has shaped the other.’1

Evidence abounds on the salience of attachment to early development and beyond. In 2018, Adshead distilled the relevance of 20 years of attachment theory to psychiatric practice.2 We argue research funders must move one step further: develop the evidence around perinatal attachment-informed interventions.

The categorisation of personality pathology into discrete disorders has been an enduring standard. However, dimensional models of personality are becoming increasingly prominent, in part owing to their superior validity and clinical utility. We contend that dimensional models also offer a unique advantage in treating mental illness. Namely, psychotherapy approaches and the components of dimensional models of personality can both be arranged hierarchically, from general to specific factors, and aligning these hierarchies provides a sensible framework for planning and implementing treatment. This article begins with a brief review of dimensional models of personality and their supporting literature. We then outline a multidimensional framework for treatment and present an illustrative fictitious clinical case before ending with recommendations for future directions in the field.