Psychosis and substance use problems: Using controlled drinking in interventions

Abstract

Substance use is a significant problem for people with severe mental health problems such as schizophrenia. It has a high prevalence and is linked to poor clinical and social outcomes. Reasons for substance using in this population are wide-ranging and overlap with those found in non-psychotic populations. Services have traditionally not been well configured to deal with people with dual problems of psychosis and substance use leading to this group's needs not being well addressed. Current guidance from the Department of Health is attempting to address this. Treatment strategies have not, as yet, been well researched. However, some conclusions can be made about the types of treatment that are acceptable and show promise. There is an emphasis on providing treatment programmes that integrate treatment for both psychosis and substance use, incorporate motivational approaches, allow flexibility in treatment goals (such as controlled drinking rather than abstinence) and incorporate some form of individual therapy (usually cognitive-behavioural) intervention. Further research is needed to expand the evidence base around interventions for psychosis and substance use.