Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A Review

Abstract

Aims: This review provides evidence of which interventions need to be part of effective outpatient integrated treatment for patients with comorbid schizophrenia and substance use disorders. Methods: A total of 14 randomized controlled trials were included. Effect sizes are provided to assess the magnitude of the treatments' efficacy. Results: Despite the studies' heterogeneity, we can conclude that certain programs (e.g. Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ) and specific interventions (e.g. motivational interviewing, family interventions) seem to be effective. Moreover, programs integrating multiple interventions are more likely to be positively related to better outcomes than single interventions. Finally, the lack of difference between effect sizes of assertive community treatment compared to case management suggests that a lower caseload is not necessary for positive treatment outcomes. Conclusion: Integrated treatment seems advantageous, although effect sizes are mostly modest. More homogeneous and qualitative sound studies are needed.

Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe

“…A rigorous assessment of comorbid dependence on alcohol or other drugs could thus help clinicians in order to anticipate typical clinical features which might orientate the choice of active components in treatment programs. These may include care in the community, assertive engagement, high intensity, small caseload, continuous responsibility and availability, consistent multidisciplinary team, a team approach, and cooperation with the patient's support network (De Witte et al, 2014).…”

Behavioral Interventions for Individuals Dually Diagnosed with a Severe Mental Illness and a Substance Use Disorder

“…For instance, does skillfully delivered MI lead to increased change talk with dual diagnosis patients, and does such an increase lead them to reduce their substance use? Finally, it will be important for future research to establish the boundaries of efficacy for MI with respect to patient psychiatric and substance use diagnoses (e.g., schizophrenia versus bipolar disorder; alcohol versus marijuana), symptoms severity, age and treatment setting, and to establish whether MI for dually-diagnosed individuals can be effectively delivered in cost-effective group formats (De Witte et al, 2014; Handmaker, Packard, & Conforti, 2002; Martino & Moyers, 2008; Westra et al, 2011). …”

“…Individual studies utilizing these interventions and narrative reviews have found evidence for their effectiveness (Baker, Hiles, Thornton, Hides, & Lubman, 2012; De Witte, Crunelle, Sabbe, Moggi, & Dom, 2014); however, systematic reviews that more carefully account for the number and quality of clinical trials have not found strong support for the efficacy of any behavioral interventions. Two recent Cochrane reviews examining nearly two decades of behavioral interventions for substance abuse treatment for dually-diagnosed individuals (Cleary, Hunt, Matheson, Siegfried, & Walter, 2008; Hunt, Siegfried, Morley, Sitharthan, & Cleary, 2013) concluded that there is insufficient evidence to support the efficacy of any one behavioral intervention over any other or even treatment as usual.…”

Schizophrenia and Addiction

“…Beginning in the late 1990s integrated treatment programs were developed and implemented in the USA and in several European countries such as the UK (Lowe and Abou-Saleh 2004), Switzerland (Moggi et al 2002), and Belgium (Morrens et al 2011). Several reports from model Table 6.1 Characteristics of patients with psychosis and comorbid substance use disorder compared to patients with psychosis only (see Mueser et al 2000, Gouzoulis-Mayfrank 2007 • High relapse rate, more frequent emergency hospital admissions • Poorer compliance, more changes in medication and intermittent high doses of antipsychotic medication • More extrapyramidal side effects including tardive dyskinesia • Poorer sociorehabilitative outcome, more financial and family problems, poorer family conditions, homelessness • Aggressive and violent behavior, more frequent conflicts with law • More frequent suicide attempts and suicides projects and over 50 controlled and quasiexperimental studies showed better longterm outcomes particularly for low-threshold, long-term outpatient therapeutic programs (Drake and Mueser 2000;Drake et al 2004Drake et al , 2008De Witte et al 2013). Such programs with out-reaching components do not require absolute abstinence; rather they aim at low patient attrition and strengthening of patient motivation to reduce substance use.…”

“…Similarly, a recent review of 14 RCTs on integrated treatment programs for dually diagnosed outpatients reported some advantages of the integrated treatment approach; however, effect sizes were mostly modest (De Witte et al 2013). The authors claimed that more homogeneous and qualitative sound studies are needed.…”