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Clinical interventions for severe mental illness and co-occurring substance use disorder

Published online by Cambridge University Press:  24 June 2014

K. T. Mueser
K. T. Mueser*
Affiliation:
Department of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
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Abstract

In order to more effectively treat substance use disorders in persons with severe mental illness, integrated treatment models have been developed for these ‘co-occurring disorders.’ The nature of clinical services provided in these programs is described in this article, with brief attention to research on these programs. Clinical services are generally guided by a stage model of change, in which the client's motivation to change (or stage of treatment: engagement, persuasion, active treatment, relapse prevention) informs the optimal selection of appropriate interventions. Psychotherapeutic services for co-occurring disorders include a range of individual (motivational interviewing, cognitive-behavioral counseling), group (stage-wise groups, social skills training, self-help), and family (single family, multifamily formats) interventions. Supplementary interventions are also commonly provided, including psychopharmacological, residential, coerced and involuntary, and vocational rehabilitation. Access to a range of different interventions for co-occurring disorders may improve the ability of clinicians to engage and tailor treatment to meet clients' unique needs. The research base supporting integrated treatment for co-occurring disorders is limited at this time owing to the small number of methodologically rigorous studies from which to draw conclusions. Nevertheless, the available evidence suggests that integrated treatment programs improve outcomes compared with nonintegrated approaches, and that more research is needed to evaluate the benefits of these programs.

Keywords

clinical interventionco-occurring disordersdual disorderspsychosocial treatmentschizophreniasevere mental illnesssubstance misuse
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 1 , February 2004 , pp. 26 - 35
Copyright
Copyright © 2004 Blackwell Munksgaard

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References

Cuffel, BJ. Comorbid substance use disorder. prevalence, patterns of use, and course, in dual diagnosis of major mental illness and substance abuse, Vol. 2. In: Drake, RE, Mueser, KT, eds. Recent Research and Clinical Implications. New Directions in Mental Health Services, Vol. 70. San Francisco, CA: Jossey-Bass, 1996: 93–105.[chapter in a book]Google Scholar
Regier, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LL, Goodwin, FK. Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. J Am Med Assoc 1990;264: 2511–2518. CrossRefGoogle ScholarPubMed
Polcin, DL. Issues in the treatment of dual diagnosis clients who have chronic mental illness. Prof Psychol Res Prac 1992;23: 30–37. CrossRefGoogle Scholar
Ridgely, MS, Goldman, HH, Willenbring, M. Barriers to the care of persons with dual diagnoses: Organizational and financing issues. Schizophr Bull 1990;16: 123–132.CrossRefGoogle ScholarPubMed
Carey, KB. Substance use reduction in the context of out-patient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Ment Health J 1996;32: 291–306.CrossRefGoogle Scholar
Drake, RE, Teague, GB, Warren, RS. Dual diagnosis. The New Hampshire Program. Addiction and Recovery 1990;10: 35–39. Google Scholar
Kavanagh, DJ. An intervention for substance abuse in schizophrenia. Behav Change 1995;12: 20–30. CrossRefGoogle Scholar
Minkoff, K. An integrated treatment model for dual diagnosis of psychosis and addiction. Hosp Community Psychiatry 1989;40: 1031–1036.Google ScholarPubMed
Ziedonis, DM, Fisher, W. Motivation-based assessment and treatment of substance abuse in patients with schizophrenia. Directions Psychiatry 1996;16: 1–7. Google Scholar
Drake, RE, Bartels, SB, Teague, GB, Noordsy, DL, Clark, RE. Treatment of substance abuse in severely mentally ill patients. J Nervous Mental Dis 1993;181: 606–611. CrossRefGoogle ScholarPubMed
Drake, RE, Morse, G, Brunette, MF, Torrey, WC. Evolving U.S. service model for patients with co-occurring severe mental illness and substance use disorder. Acta Neuropsychiatrica 2004;16: 36–40. CrossRefGoogle ScholarPubMed
Osher, FC, Kofoed, LL. Treatment of patients with psychiatric and psychoactive substance use disorders. Hosp Community Psychiatry 1989;40: 1025–1030.Google Scholar
Drake, RE, Mercer-McFadden, C, Mueser, KT, McHugo, GJ, Bond, GR. Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull 1998;24: 589–608.CrossRefGoogle ScholarPubMed
Drake, RE, Essock, SM, Shaner, A, Carey, KB, Minkoff, K, Kola, L, Lynde, D, Osher, FC, Clark, RE, Rickards, L. Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv 2001;52: 469–476.CrossRefGoogle ScholarPubMed
Ley, A, Jeffery, DP, McLaren, S, Siegfried, N. Treatment programmes for people with both severe mental illness and substance misuse. The Cochrane Library, 1999; 2. Google Scholar
Mueser, KT, Noordsy, DL, Drake, RE, Fox, L. Integrated Treatment for Dual Disorders: a Guide to Effective Practice. New York, NY: Guilford Publications, 2003. Google Scholar
Connors, GJ, Donovan, DM, Diclemente, CC, eds. Substance Abuse Treatment and the Stages of Change. New York, NY: Guilford Publications, 2001. Google Scholar
Prochaska, JO, Diclemente, CC, eds. The Transtheoretical Approach. Crossing the Traditional Boundaries of Therapy. Homewood, IL: Dow-Jones/Irwin, 1984. Google Scholar
McHugo, GJ, Drake, RE, Burton, HL, Ackerson, TH. A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. J Nervous Mental Dis 1995;183: 762–767. CrossRefGoogle ScholarPubMed
Mueser, KT, Drake, RE, Noordsy, DL. Integrated mental health and substance abuse treatment for severe psychiatric disorders. Pract Psychiatry Behav Health 1998;4: 129–139. Google Scholar
Barrowclough, C, Haddock, G, Tarrier, N, Lewis, S, Moring, J, O'Brien, R, Schofield, N, McGovern, J. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 2001;158: 1706–1713.CrossRefGoogle ScholarPubMed
Frank, AF, Gunderson, JG. The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 1990;47: 228–236.CrossRefGoogle ScholarPubMed
Gehrs, M, Goering, P. The relationship between the working alliance and rehabilitation outcomes of schizophrenia. Psychosocial Rehabilitation J 1994;18: 43–54. CrossRefGoogle Scholar
Priebe, S, Gruyters, T. The role of the helping alliance in psychiatric community care: a prospective study. J Nerv Ment Dis 1993;181: 552–557.CrossRefGoogle ScholarPubMed
Miller, WR, Rollnick, S, eds. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: Guilford Publications, 1991. Google Scholar
Alcoholics Anonymous, ed. Twelve Steps and Twelve Traditions. New York, NY: Alcoholics Anonymous World Services, Inc, 1985. Google Scholar
Hamilton, T, Sample, P, eds. The Twelve Steps and Dual Recovery. A Framework of Recovery for Those of Us with Addiction and an Emotional or Psychiatric Illness. Center City, MN: Hazelden, 1994. Google Scholar
Miller, WR, Rollnick, S, eds. Motivational Interviewing. Preparing People for Change. New York, NY: Guilford Publications, 2002. Google Scholar
Corrigan, PW, McCracken, SG, Holmes, EP. Motivational interviews as goal assessment for persons with psychiatric disability. Community Ment Health J 2001;37: 113–122.CrossRefGoogle ScholarPubMed
Kemp, R, Hayward, P, Applewhaite, G, Everitt, B, David, A. Compliance therapy in psychotic patients: Randomised controlled trial. Br Med J 1996;312: 345–349. CrossRefGoogle ScholarPubMed
Kemp, R, Kirov, G, Everitt, B, Hayward, P, David, A. Randomised controlled trial of compliance therapy: 18-month follow-up. Br J Psychiatry 1998;173: 271–272. Google Scholar
Milton, F, Patwa, VK, Hafner, RJ. Confrontation vs. belief modification in persistently deluded patients. Br J Med Psychol 1978;51: 127–130.CrossRefGoogle ScholarPubMed
Marlatt, GA, Gordon, JR, eds. Relapse Prevention. Maintenance Strategies in the Treatment of Addictive Behaviors. New York, NY: Guilford Publications, 1985. Google Scholar
Carey, KB, Carey, MP. Reasons for drinking among psychiatric out-patients: Relationship to drinking patterns. Psychol Addictive Behav 1995;9: 251–257. CrossRefGoogle Scholar
Noordsy, DL, Drake, RE, Teague, GB, Osher, FC, Hurlbut, SC, Beaudett, MS, Paskus, TS. Subjective experiences related to alcohol abuse among schizophrenics. J Nervous Mental Dis 1991;179: 410–414. CrossRefGoogle ScholarPubMed
Spencer, C, Castle, D, Michie, PT. Motivations that maintain substance use among individuals with psychotic disorders. Schizophr Bull 2002;28: 233–247.CrossRefGoogle ScholarPubMed
Warner, R, Taylor, D, Wright, J, Sloat, A, Springett, G, Amold, S, Weinberg, H. Substance use among the mentally ill: Prevalence, reasons for use and effects on illness. Am J Orthopsychiatry 1994;64: 30–39.CrossRefGoogle ScholarPubMed
Tarrier, N, Haddock, G. Cognitive-Behavioral Therapy for Schizophrenia. A Case Formulation Approach, in Treating Chronic and Severe Mental Disorders: a Handbook of Empicially Supported Interventions. In: Hoffman, SG, Tompson, MC, eds. New York, NY: Guilford Publications, 2002: 69–95. Google Scholar
Mueser, KT, Noordsy, DL. Group treatment for dually diagnosed clients, in dual diagnosis of major mental illness and substance abuse,Vol. 2 . In: Drake, RE, Mueser, KT, eds. Recent Research and Clinical Implications.. Vol. 70 San Francisco, CA: Jossey-Bass, 1996: 33–51. Google Scholar
Carmichael, D, Tackett-Gibson, M, O'Dell, L, Jayasuria, B, Jordan, J, Menon, R. Texas Dual Diagnosis Project Evaluation Report 1997–98. College Station, TX: Public Policy Research Institute/Texas A&M University, 1998. Google Scholar
Drake, RE, McHugo, GJ, Clark, RE, Teague, GB, Xie, H, Miles, K, Ackerson, TH. Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. Am J Orthopsychiatry 1998;68: 201–215.CrossRefGoogle ScholarPubMed
Bellack, AS, Mueser, KT, Gingerich, S, Agresta, J, eds. Social Skills Training for Schizophrenia: a Step-by-Step Guide. New York, NY: Guilford Publications, 1997. Google Scholar
Liberman, RP, Derisi, WJ, Mueser, KT, eds. Social Skills Training for Psychiatric Patients. Needham Heights, MA: Allyn & Bacon, 1989. Google Scholar
Bellack, AS, Diclemente, CC. Treating substance abuse among patients with schizophrenia. Psychiatr Serv 1999;50: 75–79.CrossRefGoogle ScholarPubMed
Bennett, ME, Bellack, AS, Gearson, JS. Treating substance abuse in schizophrenia: An initial report. J Subst Abuse Treat 2001;20: 163–175.CrossRefGoogle Scholar
Roberts, LJ, Shaner, A, Eckman, TA, eds. Overcoming Addictions: Skills Training for People with Schizophrenia. New York, NY: W.W. Norton, 1999. Google Scholar
Jerrell, JM, Ridgely, MS. Comparative effectiveness of three approaches to serving people with severe mental illness and substance use disorders. J Nervous Mental Dis 1995;183: 566–576. CrossRefGoogle Scholar
Room, R. Alcoholics Anonymous as a social movement. In: McCrady, BS, Miller, WR, eds. Research on Alcoholics Anonymous. New Brunswick, NJ: Rutgers Center of Alcohol Studies, 1993: 167–189. Google ScholarPubMed
Vogel, HS, Knight, E, Laudet, AB, Magura, S. Double Trouble in Recovery. Self-help for the dually diagnosed. Psychiatr Rehabil J 1998;21: 356–364. CrossRefGoogle Scholar
Noordsy, DL, Schwab, B, Fox, L, Drake, RE. The role of self-help programs in the rehabilitation of persons with severe mental illness and substance use disorders. Community Ment Health J 1996;32: 71–81.CrossRefGoogle ScholarPubMed
Bellack, AS, Morrison, RL, Wixted, JT, Mueser, KT. An analysis of social competence in schizophrenia. Br J Psychiatry 1990;156: 809–818.CrossRefGoogle Scholar
McDowell, D, Galanter, M, Goldfarb, L, Lifshutz, H. Spirituality and the treatment of the dually-diagnosed: An investigation of patient and staff attitudes. J Addictive Dis 1996;15: 55–68. CrossRefGoogle ScholarPubMed
Meissen, G, Powell, TJ, Wituk, SA, Girrens, K, Arteaga, S. Attitudes of AA contact persons toward group participation by persons with a mental illness. Psychiatr Serv 1999;50: 1079–1081.CrossRefGoogle ScholarPubMed
Trumbetta, SL, Mueser, KT, Quimby, E, Bebout, R, Teague, GB. Social networks and clinical outcomes of dually diagnosed homeless persons. Behav Ther 1999;30: 407–430. CrossRefGoogle Scholar
Clark, RE. Family support for persons with dual disorders, in dual diagnosis of major mental illness and substance abuse,Vol. 2 . In: Drake, RE, Mueser, KT, eds. Recent Research and Clinical Implications. New Directions for Mental Health Services, Vol. 70. San Francisco, CA: Jossey-Bass, 1996: 65–78. Google Scholar
Clark, RE. Family support and substance use outcomes for persons with mental illness and substance use disorders. Schizophr Bull 2001;27: 93–101.CrossRefGoogle ScholarPubMed
Caton, CL, Shrout, PE, Eagle, PF, Opler, LA, Felix, AF, Dominguez, B. Risk factors for homelessness among schizophrenic men: a case-control study. Am J Public Health 1994;84: 265–270.CrossRefGoogle ScholarPubMed
Caton, CLM, Shrout, PE, Dominguez, B, Eagle, PF, Opler, LA, Cournos, F. Risk factors for homelessness among women with schizophrenia. Am J Public Health 1995;85: 1153–1156.CrossRefGoogle ScholarPubMed
Dixon, L, McNary, S, Lehman, A. Substance abuse and family relationships of persons with severe mental illness. Am J Psychiatry 1995;152: 456–458.Google ScholarPubMed
Salyers, MP, Mueser, KT. Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia. Schizophr Res 2001;48: 109–123.CrossRefGoogle Scholar
Butzlaff, RL, Hooley, JM. Expressed emotion and psychiatric relapse. Arch Gen Psychiatry 1998;55: 547–552.CrossRefGoogle ScholarPubMed
Fichter, MM, Glynn, SM, Weyer, S, Liberman, RP, Frick, U. Family climate and expressed emotion in the course of alcoholism. Fam Process 1997;36: 203–221.CrossRefGoogle ScholarPubMed
Pitschel-Walz, G, Leucht, S, Bäuml, J, Kissling, W, Engel, R R. The effect of family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Schizophr Bull 2001;27: 73–92.CrossRefGoogle ScholarPubMed
Stanton, MD, Shadish, WR. Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies. Psychol Bull 1997;122: 170–191.CrossRefGoogle ScholarPubMed
Barrowclough, C. Family intervention for substance misuse in psychosis, in substance misuse. In: Graham, HL, Copello, A, Birchwood, MJ, Mueser, KT, eds. Psychosis: Approaches to Treatment and Service Delivery. Chichester: John Wiley & Sons, 2003: 227–243. Google Scholar
Mueser, KT, Fox, L. A family intervention program for dual disorders. Community Ment Health J 2002;38: 253–270.CrossRefGoogle ScholarPubMed
Drake, RE, Xie, H, McHugo, GJ, Green, AI. The effects of clozapine on alcohol and drug use disorders among schizophrenic patients. Schizophr Bull 2000;26: 441–449.CrossRefGoogle Scholar
Mueser, KT, Noordsy, DL, Fox, L, Wolfe, R. Disulfiram treatment for alcoholism in severe mental illness. Am J Addict 2003;12: 242–252.CrossRefGoogle ScholarPubMed
Anton, RF, Moak, DH, Waid, LR, Latham, PK, Malcolm, RJ, Dias, JK. Naltrexone and cognitive behavioral therapy for the treatment of out-patient alcoholics: Results of a placebo-controlled trial. Am J Psychiatry 1999;156: 1758–1764.Google ScholarPubMed
Sengupta, A, Drake, RE, McHugo, GJ. The relationship between substance use disorder and vocational functioning among persons with severe mental illness. Psychiatr Rehabil J 1998;22: 41–45. CrossRefGoogle Scholar
Brunette, MF, Drake, RE, Woods, M, Hartnett, T. A comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatr Serv 2001;52: 526–528.CrossRefGoogle ScholarPubMed
Rosen, MI, Rosenheck, R. Substance use and assignment of representative payees. Psychiatr Serv 1999;50: 95–98.CrossRefGoogle ScholarPubMed
O'Keefe, C, Potenza, DP, Mueser, KT. Treatment outcomes for severely mentally ill patients on conditional discharge to community-based treatment. J Nervous Mental Dis 1997;185: 409–411. CrossRefGoogle ScholarPubMed
Swartz, MS, Swanson, JW, Wagner, HR, Burns, BJ, Hiday, VA, Borum, R. Can involuntary out-patient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry 1999;156: 1968–1975.Google Scholar
Kavanagh, DJ, Young, R, White, A, Saunders, JB, Shockley, N, Wallis, J, Clair, A. Start over and survive: a brief intervention for substance misuse in early psychosis. In: Graham, H L, Copello, A, Birchwood, MJ, Mueser, KT Chichester eds. Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery. Chichester, UK: John Wiley & Sons, 2003: 244–258. Google Scholar
Edens, JF, Peters, RH, Hills, HA. Treating prison inmates with co-occurring disorders: An integrative review of existing programs. Behav Sci Law 1997;15: 439–457.3.0.CO;2-X>CrossRefGoogle ScholarPubMed