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Psychological treatments effective for psychosis with substance misuse
Jul 12, 2004, 23:11, Reviewed by: Dr.
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By Ashwin, UK Correspondent,
The first randomised controlled trial has been carried out to show that a psychological treatment programme can effectively treat people with psychosis who are also using drugs or alcohol.
Many people with psychosis use drugs and alcohol, and prevalence rates for abuse or dependence in this group may be as high as 60%. This combination of problems poses difficulties for the clinician, since it can involve a worsening of symptoms, relapse, violence and suicide.
There are few studies of psychological treatments for this group of people. Traditionally, those with substance misuse problems have either been excluded from trials of cognitive behaviour therapy (CBT) for psychosis, or their substance misuse problems have not been a focus of treatment.
In recent years in Manchester a mental health team has been developing a treatment approach that takes account of the dual and interactive nature of psychosis and substance misuse. The researchers carried out a randomised controlled trial designed to investigate symptoms, substance use, functioning and health economy outcomes for patients with schizophrenia and their carers after a CBT programme.
The treatment approach combined motivational interviewing with family and individual CBT. A number of outcomes were assessed up to 18 months after the programme.
It was found that there were significant improvements in patient functioning among the CBT treatment group. Despite the CBT requiring extensive staff input, there was no increase in health service costs when compared to the control group, largely due to more in-patient stays by control patients.
It is difficult to make strong conclusions from the study because of the small sample size. However, this work is now being taken forward in a large multi-site trial at the University of Manchester and the Institute of Psychiatry, London, funded by the Medical Research Council and the Department of Health.
- Royal College of Psychiatrists
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