Substance Use in Psychosis: What Can Be Done about It?

The use of alcohol and illicit substances is common among patients with schizophrenia. Whilst it is generally believed that the use of such agents is detrimental to mental health, and can worsen the longitudinal illness trajectory, little systematic research has attempted to understand motivations for use in this population, nor tried to use such knowledge to inform treatment. We report here a two-part program aimed at addressing this gap. Part 1 was a survey of 69 psychosis patient using a series of structured measures to understand motivation for substance use. Part 2 was a group-based intervention using a harm-minimisation approach, informed by the results from Part 1, to address substance use in psychotic patients. Outcomes for the first 22 patients reveal the intervention group to show stability with respect to BPRS scores (the controls showed a significant worsening), and a significant reduction in the Severity of Dependence Scale, Drug Abuse Screening Test and AUDIT. These results suggest that a reduction in substance use in psychotic patients can be effected by a targeted group-based approach.