Psychosocial Treatments for People with Co-occurring Severe Mental Illnesses and Substance Use Disorders (Dual Diagnosis): A Review of Empirical Evidence

Abstract

Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.

Recovery From Comorbidity

“…The evidence supporting current treatment approaches in comorbidity is limited in quantity, short-term, methodologically limited, and needing replication (Farren & McElroy, 2010;Horsfall et al, 2009;Tiet & Mausbach, 2007). Modalities operating in isolation tend to fail: multidisciplinary and integrated approaches are associated with effectiveness at 12-to 24-month follow-up in some research (Farren, 2011;Howard et al, 2007;Moggi, Brodbeck, Költzsch, Hirsbrunner, & Bachmann, 2002;Moggi, Ouimette, Finney, & Moos, 1999).…”

“…Questions needing further research in integrated and other multidisciplinary approaches include comparisons of parallel versus sequential integration. An array of diverse approaches are used in practice in Australia and internationally ranging from medication to individual or group psychotherapies to therapeutic communities and peer-support programs-there is no clear evidence singling out any particular treatment approach as advantageous although all serve a role (Drake, 2007;Horsfall et al, 2009;Iovieno, Tedeschini, Bentley, Evins, & Papakostas, 2011;Kay-Lambkin et al, 2004;Tiet & Mausbach, 2007). There is little research looking at treatment approaches in particular combinations of comorbidity or beyond actively concurrent comorbidity (Tiet & Mausbach, 2007).…”

“…Methodological challenges to quantitative research into comorbidity abound: maintaining consistent study settings; sample populations and diagnostic criteria; differences in diagnostic validity between clinicians and researchers; sparse descriptions of interventions make replicability difficult; consistency and reliability of screening and questionnaire methods; the need to exclude the more severely affected or currently ill; attrition; the impact of social/cultural/legal/ drug nature/definitional changes over time; gauging to what extent cultural differences have impact on international generalizability; and the conflation of abstinent ex-drinkers with abstinent never-drinkers (Crawford et al, 2003;Drake, 2007;Horsfall et al, 2009;Mueser et al, 1998;L. Schmidt, 1991;Tarrier & Sommerfield, 2003).…”

“…The focus is on the quantitative analysis of specific etically hypothesized criteria and associations, with little underlying or associated qualitative or exploratory research (Boschloo et al, 2011;Horsfall et al, 2009). That neither psychology nor biology operates exclusively from the other is a well-established quantifiable phenomenon (Eisenberg, 1986).…”

Addiction and Mental Health Across the Lifespan: An Overview of Some Contemporary Issues

“…Estimates of current SUDs and lifetime prevalence vary (Horsfall, Cleary, Hunt, & Walter, 2009). For example, recent systematic reviews and meta-analyses which aimed to estimate the prevalence rates of SUDs in people diagnosed with bipolar disorder and mood and anxiety disorders reported comorbidity to be highly prevalent between SUDs, mood and anxiety disorders and highly prevalent in hospital and community-based samples (Hunt, Malhi, Cleary, Lai, & Sitharthan, 2016a;Hunt, Malhi, Cleary, Lai, Sitharthan, 2016b;Lai et al, 2015).…”