Treatment development for psychosis and co-occurring substance misuse: A descriptive review

Abstract

Background: It is common for people with psychosis to have co-occurring drug or alcohol problems. This combination of problems is associated with poor outcomes for clients and presents many challenges for services.

Aims: This review aims to discuss contextual issues underlying treatment difficulties, to briefly review the treatment literature to date and to describe a randomized controlled treatment trial (RCT) currently being conducted in the UK.

Methods: A descriptive review.

Results: Consensus agreement emphasizes the need for integrated treatment strategies that match the client's current level of motivation. There have been encouraging results from recent studies evaluating motivational strategies, either alone or in combination with CBT. Whilst for many clients with established illness and substance using histories, brief therapy does not seem to be adequate, longer term interventions show promise. A current RCT evaluating motivational interviewing with CBT is described.

Conclusions: The evidence base for treatment recommendations is still quite small. The MIDAS trial will hopefully make a significant contribution to the literature on treatment options for this high risk group.

Declaration of interest: The MIDAS trial is funded by the Medical Research Council and the Department of Health.

Keywords:

• Co-occurring substance misuse
• integrated treatment strategies
• randomized controlled treatment trial