Start Over and Survive: A Brief Intervention for Substance Misuse in Early Psychosis

Abstract

At around 15 years of age Jake began using drugs occasionally with his friends. During his late teenage years, he wanted to become a DJ and spent a lot of time at clubs, where he used amphetamine and ecstasy. His use of alcohol and cannabis also increased at this time, as he found these substances would "calm his nerves" and help him "chill out". When Jake was 21, his parents started to put pressure on him to get a "proper job", and he moved out of their home to live with his girlfriend, who occasionally used crack-cocaine. Eventually Jake tried crack-cocaine himself. Substance use was very common among Jake's friends, and he enjoyed the way it made him feel. His drug and alcohol use continued to increase to the point where, at the age of 22, Jake was spending all his money on alcohol/drugs, and his use was causing arguments with his girlfriend. Around this time, Jake began to experience auditory hallucinations. He noticed that following a period of intense drug use the voices became "worse" and more "intense" but found that if he continued to use the drugs he felt good again. He was admitted to an acute psychiatric inpatient unit, and on his discharge the voices had stopped. A few months later he began using crack-cocaine again, and whenever he had the money or could get credit from dealers, he would spend about £60 over one or two days on this. He was also spending about £30 per week on cannabis and drinking up to three cans of extra-strong lager every day. Simultaneously, Jake's auditory hallucinations became more intense and commanding, telling him that his next-door neighbour was "evil". Acting on the instructions of the voices, Jake tried to set fire to his next-door neighbour's flat. As a result of this, Jake was admitted to hospital for a second time.

The UK national evaluation of the development and impact of Early Intervention Services (the National EDEN studies): study rationale, design and baseline characteristics

“…The GAF is widely used in studies of treatment effectiveness and the relative simplicity, reliability and validity of scale has seen it used in a wide variety of clinical and research settings Substance misuse: The Kavanagh drug check (revised version) was used to assess the consumption of cannabis, alcohol and class A drugs within the last month Deliberate self‐harm and aggression: Violent incidents were assessed by self‐report and information from collateral informants including health professionals, using a shortened version of the MacArthur study questionnaire, modified for UK use …”

“…(revised version) was used to assess the consumption of cannabis, alcohol and class A drugs within the last month. 34…”

A brief motivational intervention for substance misuse in recent‐onset psychosis

“…Biographical details and the history of the disorder and its treatment were obtained from the patient, relatives and hospital file. Screening for misuse used the Alcohol Use Disorders Identification Test (AUDIT) [12], the Severity of Dependence Scale (SDS) [13] and the DrugCheck [14]. The DrugCheck comprised quantity/frequency indices over the previous 3 months, plus a 13-item problem list (PL) that assessed the functional impact of the most problematic substance.…”

“…The DrugCheck comprised quantity/frequency indices over the previous 3 months, plus a 13-item problem list (PL) that assessed the functional impact of the most problematic substance. All three measures have high sensitivity and specificity in detecting substance misuse in psychosis [14,15]. Diagnoses of substance use disorders were confirmed using the Composite International Diagnostic Interview-Auto v2.1 (CIDI-Auto) [16], sections B (tobacco), J (alcohol) and L (substance-related disorders), which has acceptable reliability and validity in substance misuse [17].…”

The lived experience of community mental health nurses working with people who have dual diagnosis: a phenomenological study

“…(2000) have shown that psycho‐education group therapy and integrated group therapy, respectively, are effective with people who have bipolar disorders and substance misuse problems. Researchers in Australia evaluated a brief intervention for dual diagnosis and showed that motivational interviewing was associated with reduction in substance misuse compared with standard care (Kavanagh et al . 2003).…”