Current Psychiatry Reports

, Volume 3, Issue 5, pp 418–422 | Cite as

Managing comorbid schizophrenia and substance abuse

  • Robert E. Drake
  • Kim T. Mueser

Abstract

Effective treatments for co-occurring schizophrenia and substance abuse have emerged over the past 15 years. They involve integration and melding of mental health and substance abuse treatments, helping people to acquire the skills and supports they need to manage both illnesses and to pursue functional goals, and a comprehensive, long-term approach to recovery. Further research is needed to refine specific interventions and to improve knowledge regarding implementing integrated treatment settings in routine mental health programs.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Pepper B, Krishner MC, Ryglewicz H: The young adult chronic patient: overview of a population. Hosp Community Psychiatry 1981, 32:463–469.PubMedGoogle Scholar
  2. 2.
    Caton CLM: The new chronic patient and the system of community care. Hosp Community Psychiatry 1981, 32:475–478.PubMedGoogle Scholar
  3. 3.
    Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 1990, 264:2511–2518.PubMedCrossRefGoogle Scholar
  4. 4.
    Swofford C, Kasckow J, Scheller-Gilkey G, et al.: Substance use: a powerful predictor of relapse in schizophrenia. Schizophr Res 1996, 20:145–151.PubMedCrossRefGoogle Scholar
  5. 5.
    Haywood TW, Kravitz HM, Grossman LS, et al.: Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995, 152:856–861.PubMedGoogle Scholar
  6. 6.
    Cuffel B, Shumway M, Chouljian T: A longitudinal study of substance use and community violence in schizophrenia. J Nerv Ment Dis 1994, 182:704–708.PubMedCrossRefGoogle Scholar
  7. 7.
    Abram KM, Teplin LA: Co-occurring disorders among mentally ill jail detainees: implications for public policy. Am Psychol 1991, 46:1036–1045.PubMedCrossRefGoogle Scholar
  8. 8.
    Caton CLM, Shrout PE, Eagle PF, et al.: Risk factors for homelessness among schizophrenic men: a case-control study. Am J Public Health 1994, 84:265–270.PubMedGoogle Scholar
  9. 9.
    Rosenberg SD, Goodman LA, Osher FC, et al.: Prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness. Am J Public Health 2001, 91:31–37.PubMedGoogle Scholar
  10. 10.
    Ridgely MS, Osher FC, Goldman HH, et al.: Executive Summary: Chronic Mentally Ill Young Adults with Substance Abuse Problems: A Review of Research, Treatment, and Training Issues. Baltimore, MD: Mental Health Services Research Center, University of Maryland School of Medicine Press; 1987.Google Scholar
  11. 11.
    Drake RE, Wallach MA: Dual diagnosis: 15 year of progress. Psychiatr Serv 2000, 51:1126–1129.PubMedCrossRefGoogle Scholar
  12. 12.
    Barrowclough C, Haddock G, Tarrier N, et al.: Cognitive behavioral intervention for clients with severe mental illness who have a substance misuse problem. Psychiatr Rehab Skills 2000, 4:216–233.Google Scholar
  13. 13.
    Bellack AS, DiClemente CC: Treating substance abuse among patients with schizophrenia. Psychiatr Serv 1999, 50:75–80.PubMedGoogle Scholar
  14. 14.
    Carey KB: Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach. Community Ment Health J 1996, 32:291–306.PubMedCrossRefGoogle Scholar
  15. 15.
    Mueser KT, Drake RE, Noordsy DL: Integrated mental health and substance abuse treatment for severe psychiatric disorders. J Pract Psychiatry Behav Health 1998, 4:129–139. This is an excellent description of current treatment approaches.Google Scholar
  16. 16.
    Minkoff K: An integrated treatment model for dual diagnosis of psychosis and addiction. Hosp Community Psychiatry 1989, 40:1031–1036.PubMedGoogle Scholar
  17. 17.
    Mead S, Copeland ME: What recovery means to us: consumers’ perspectives. Community Ment Health J 2000, 36:315–328.PubMedCrossRefGoogle Scholar
  18. 18.
    Torrey WC, Wyzik P: The recovery vision as a service improvement guide for community mental health center providers. Community Ment Health J 2000, 36:209–216.PubMedCrossRefGoogle Scholar
  19. 19.
    Drake RE, Mercer-McFadden C, Mueser KT, et al.: Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull 1998, 24:589–608. This paper presents the most comprehensive review of empirical studies currently available.PubMedGoogle Scholar
  20. 20.
    Ley A, Jeffery DP, McLaren S, et al.: Treatment programmes for people with both severe mental illness and substance misuse. Available at: http://www.update-software.com/ cochrane/cochrane-frame.html. Accessed February 1999.Google Scholar
  21. 21.
    Mercer-McFadden C, Drake RE, Brown NB, et al.: The community support program demonstrations of services for young adults with severe mental illness and substance use disorders 1987 to 1991. Psychiatr Rehab J 1997, 20:13–24.Google Scholar
  22. 22.
    Detrick A, Stiepock V: Treating persons with mental illness, substance abuse, and legal problems: the Rhode Island experience. In Innovative Community Mental Health Programs, New Directions for Mental Health Services, no 56. Edited by Stein LI. San Francisco, CA: Jossey-Bass; 1992.Google Scholar
  23. 23.
    Drake RE, McHugo G, Noordsy DL: Treatment of alcoholism among schizophrenic outpatients: four-year outcomes. Am J Psychiatry 1993, 50:328–329.Google Scholar
  24. 24.
    Durell J, Lechtenberg B, Corse S, et al.: Intensive case management of persons with chronic mental illness who abuse substances. Hosp Community Psychiatry 1993, 44:415–416.PubMedGoogle Scholar
  25. 25.
    Meisler N, Blankertz L, Santos AB, et al.: Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders. Community Ment Health J 1997, 33:113–122.PubMedCrossRefGoogle Scholar
  26. 26.
    Drake RE, Goldman HH, Leff HS, et al.: Implementing evidence-based practices in routine mental health service settings. Psychiatr Serv 2001, 52:179–182.PubMedCrossRefGoogle Scholar
  27. 27.
    Godley SH, Hoewing-Roberson R, Godley MD: Final MISA Report. Bloomington, IL: Lighthouse Institute; 1994.Google Scholar
  28. 28.
    Jerrell JM, Ridgely MS: Comparative effectiveness of three approaches to serving people with severe mental illness ad substance abuse disorders. J Nerv Ment Dis 1995, 183:566–576.PubMedCrossRefGoogle Scholar
  29. 29.
    Drake RE, Yovetich NA, Bebout RR, et al.: Integrated treatment for dually diagnosed homeless adults. J Nerv Ment Dis 1997, 185:298–305.PubMedCrossRefGoogle Scholar
  30. 30.
    Carmichael D, Tackett-Gibson M, Dell O, et al.: Texas Dual Diagnosis Project Evaluation Report 1997 to 1998. College Station, TX: Public Policy Research Institute/Texas A&M University; 1998.Google Scholar
  31. 31.
    Drake RE, McHugo GJ, Clark RE, et al.: Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. Am J Orthopsychiatry 1998, 68:201–215.PubMedCrossRefGoogle Scholar
  32. 32.
    Ho AP, Tsuang JW, Liberman RP, et al.: Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence. Am J Psychiatry 1999, 156:1765–1770.PubMedGoogle Scholar
  33. 33.
    Brunette M, Drake RE, Woods M, et al.: Effectiveness of long-term residential treatment for persons with co-occurring severe mental illness and substance use disorder. Psychiatr Serv 2001, 52:526–528.PubMedCrossRefGoogle Scholar
  34. 34.
    Barrowclough C, Haddock G, Tarrier N, et al.: Randomised controlled trial of motivational interviewing and cognitive behavioral intervention for schizophrenia patients with associated drug or alcohol misuse. Am J Psychiatry 2001, In press.Google Scholar
  35. 35.
    Havassy BE, Shopshire MS, Quigley LA: Effects of substance dependence on outcomes of patients in a randomized trial of two case management models. Psychiatr Serv 2000, 51:639–644.PubMedCrossRefGoogle Scholar
  36. 36.
    Osher FC, Kofoed LL: Treatment of patients with psychiatric and psychoactive substance use disorders. Hosp Community Psychiatry 1989, 40:1025–1030.PubMedGoogle Scholar
  37. 37.
    McHugo GJ, Drake RE, Burton HL, et al.: A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. J Nerv Ment Dis 1995, 183:762–767. This paper describes current thinking about stages of treatment and measurement of stages.PubMedCrossRefGoogle Scholar
  38. 38.
    Owen C, Rutherford V, Jones M, et al.: Noncompliance in psychiatric aftercare. Community Ment Health J 1997, 33:25–34.PubMedCrossRefGoogle Scholar
  39. 39.
    Hellerstein DJ, Rosenthal RN, Miner CR: A prospective study of integrated outpatient treatment for substanceabusing schizophrenic patients. Am J Addict 1995, 42:33–42.CrossRefGoogle Scholar
  40. 40.
    Test MA, Wallish LS, Allness DG, et al.: Substance use in young adults with schizophrenic disorders. Schizophr Bull 1989, 15:465–476.PubMedGoogle Scholar
  41. 41.
    Ziedonis D, Trudeau K: Motivation to quit using substances among individuals with schizophrenia: implications for a motivation-based treatment model. Schizophr Bull 1997, 23:229–238.PubMedGoogle Scholar
  42. 42.
    Miller W, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press; 1991.Google Scholar
  43. 43.
    Carey KB, Maisto SA, Carey MP, et al.: Measuring readiness-tochange substance misuse among psychiatric outpatients: reliability and validity of self-report measures. J Stud Alcohol 2001, In press.Google Scholar
  44. 44.
    Carey KB, Carey MP, Maisto SA, et al.: Enhancing readiness-tochange substance use in persons with schizophrenia: A feasibility study. Psychiatr Serv 2001, In press.Google Scholar
  45. 45.
    Roberts LJ, Shaner A, Eckman T: Overcoming Addictions: Skills Training for People with Schizophrenia. New York: Norton Professional Books; 1999.Google Scholar
  46. 46.
    Alverson H, Alverson M, Drake RE: An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness. Community Ment Health J 2000, 36:557–569.PubMedCrossRefGoogle Scholar
  47. 47.
    Greenfield SF, Weiss RD, Tohen M: Substance abuse and the chronically mentally ill: A description of dual diagnosis treatment services in a psychiatric hospital. Community Ment Health J 1995, 31:265–278.PubMedCrossRefGoogle Scholar
  48. 48.
    Drake RE, Mueser KT: Psychosocial approaches to dual diagnosis. Schizophr Bull 2000, 26:105–118.PubMedGoogle Scholar
  49. 49.
    Jerrell JM, Ridgely MS: Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs. Psychiatr Serv 1999, 50:109–112.PubMedGoogle Scholar
  50. 50.
    McHugo GJ, Drake RE, Teague GB, et al.: Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatr Serv 1999, 50:818–824.PubMedGoogle Scholar
  51. 51.
    Rach-Beisel J, Scott J, Dixon L: Co-occurring severe mental illness and substance use disorders: a review of recent research. Psychiatr Serv 1999, 50:1427–1434.Google Scholar
  52. 52.
    Mueser KT, Bellack A, Blanchard J: Comorbidity of schizophrenia and substance abuse. J Consult Clin Psychol 1997, 60:845–856.Google Scholar
  53. 53.
    Osher FC, Drake RE: Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders. Am J Orthopsychiatry 1996, 66:4–11.PubMedCrossRefGoogle Scholar
  54. 54.
    Woody G: The challenge of dual diagnosis. Alcohol Health Res World 1996, 20:76–80.Google Scholar
  55. 55.
    Bartels SJ, Teague GB, Drake RE, et al.: Service utilization and costs associated with substance abuse among rural schizophrenic patients. J Nerv Ment Dis 1993, 181:227–232.PubMedCrossRefGoogle Scholar
  56. 56.
    Dickey B, Azeni H: Persons with dual diagnosis of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health 1996, 86:973–977.PubMedCrossRefGoogle Scholar
  57. 57.
    Clark RE: Family costs associated with severe mental illness and substance use. Hosp Community Psychiatry 1994, 45:808–813.PubMedGoogle Scholar
  58. 58.
    Clark RE, Teague GB, Ricketts SK, et al.: Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Serv Res 1998, 33:1283–1306.Google Scholar
  59. 59.
    Jerrell JM: Cost-effective treatment for persons with dual disorder. In Dual Diagnosis of Major Mental Illness and Substance Disorder: II. Recent Research and Clinical Implications. New Directions for Mental Health Services, no 70. Edited by Drake RE, Mueser KT. San Francisco, CA: Jossey-Bass; 1996:79–91.Google Scholar
  60. 60.
    O’Keefe C, Potenza DP, Mueser KT: Treatment outcomes for severely mentally ill patients on conditional discharge to community-based treatment. J Nerv Ment Dis 1997, 185:409–411.PubMedCrossRefGoogle Scholar
  61. 61.
    Harris M: Trauma Recovery and Empowerment Manual. New York: The Free Press; 1998.Google Scholar
  62. 62.
    Ries RK, Dyck DG: Representative payee practices of community mental health centers in Washington State. Psychiatr Serv 1997, 48:811–814.PubMedGoogle Scholar
  63. 63.
    Shaner A, Roberts LJ, Eckman TA, et al.: Monetary reinforcement of abstinence from cocaine among mentally ill patients with cocaine dependence. Psychiatr Serv 1997, 48:807–810.PubMedGoogle Scholar
  64. 64.
    Zimmet SV, Strous RD, Burgess ES, et al.: Effects of clozapine on substance use in patients with schizophrenia and schizoaffective disorders: A retrospective survey. J Clin Psychopharmacol 2000, 20:94–98.PubMedCrossRefGoogle Scholar
  65. 65.
    Mueser KT, Noordsy DL, Essock S: Use of disulfiram in the treatment of patients with dual diagnosis. Am J Addictions 2001, In press.Google Scholar
  66. 66.
    Brunette MF, Drake RE: Gender differences in patients with schizophrenia and substance abuse. Compr Psychiatry 1997, 38:109–116.PubMedCrossRefGoogle Scholar
  67. 67.
    Alexander MJ: Women with co-occurring addictive and mental disorders: an emerging profile of vulnerability. Am J Orthopsychiatry 1996, 66:61–70.PubMedCrossRefGoogle Scholar
  68. 68.
    Quimby E: Homeless clients’ perspectives on recovery in the Washington, DC Dual Diagnosis Project. Contemp Drug Problems Summer 1995, 265–289.Google Scholar
  69. 69.
    Goodman LA, Rosenberg SD, Mueser KT, et al.: Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment, and future research directions. Schizophr Bull 1997, 23:685–696.PubMedGoogle Scholar
  70. 70.
    Mueser KT, Goodman LB, Trumbetta SL, et al.: Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 1998, 66:493–499.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Robert E. Drake
    • 1
  • Kim T. Mueser
    • 1
  1. 1.New Hampshire-Dartmouth Psychiatric Research CenterLebanonUSA

Personalised recommendations