Community Mental Health Journal

, Volume 32, Issue 3, pp 291–306 | Cite as

Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach

  • Kate B. Carey


A conceptual model for reducing substance use within the context of outpatient psychiatric treatment is described. The proposed model incorporates four themes from the psychological treatment literature: treatment intensity, stages of change, motivational interventions, and harm reduction. The five steps of the model include (1) establishing a working alliance, (2) evaluating the cost-benefit ratio of continued substance use, (3) individualizing goals for change, (4) building an environment and lifestyle supportive of abstinence, and (5) anticipating and coping with crises. This model attempts to integrate clinical realities of mental health treatment with empirically-grounded strategies applicable to substance abuse problems.


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  1. Akerlind, I. & Hornquist, J.O. (1992). Loneliness and alcohol abuse: A review of evidence of an interplay.Soc. Sci. Med., 34, 405–414.PubMedCrossRefGoogle Scholar
  2. Bandura, A. (1986).Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  3. Bergman, H., & Harris, M. (1985). Substance abuse among young adult chronic patients.Psychosocial Rehabilitation Journal, 9, 49–54.Google Scholar
  4. Blane, H.T., & Leonard, K.E. (1987).Psychological theories of drinking and alcoholism. New York: Guilford.Google Scholar
  5. Bowers, M.B., Mazure, C.M., Nelson, C.J., & Jatlow, P.I. (1990). Psychotogenic drug abuse and neuroleptic response.Schizophrenia Bulletin, 16, 81–85.PubMedGoogle Scholar
  6. Brehm, S.S., & Brehm, J.W. (1981).Psychological reactance: A theory of freedom and control. New York: Academic Press.Google Scholar
  7. Carey, K.B. (1989). Treatment of the mentally ill chemical abuser: Description of the Hutchings day treatment program.Psychiatric Quarterly, 60, 303–316.PubMedCrossRefGoogle Scholar
  8. Carey, K.B. (1995). Treatment of substance abuse with schizophrenia. In A.F. Lehman & L. Dixon (Eds.)Double jeopardy: Chronic mental illness and substance abuse. London: Harwood.Google Scholar
  9. Carey, K.B., & Carey, M.P. (1990). Enhancing the treatment attendance of mentally ill chemical abusers.Journal of Behavior Therapy and Experimental Psychiatry, 21, 205–209.PubMedCrossRefGoogle Scholar
  10. Carey, M.P., Carey, K.B., & Meisler, A.W. (1991). Psychiatric symptoms in mentally ill chemical abusers.Journal of Nervous and Mental Disease, 179, 136–138.PubMedCrossRefGoogle Scholar
  11. Dixon, L., Haas, G., Weiden, P., Sweeney, J. & Frances, A. (1990). Acute effects of drug abuse in schizophrenic patients: Clinical observations and patients' self-reports.Schizophrenia Bulletin, 16, 69–79.PubMedGoogle Scholar
  12. Drake, R.E., Osher, F.C. & Wallach, M.A. (1989). Alcohol use and abuse in schizophrenia: A prospective community study.Journal of Nervous and Mental Disease, 177, 408–414.PubMedCrossRefGoogle Scholar
  13. Drake, R.E., Teague, G.B., & Warren, S.R. (1990). Dual diagnosis: The New Hampshire Program.Addiction and Recovery, June, 35–39.Google Scholar
  14. Drake, R.E., & Wallach, M.A. (1989). Substance abuse among the chronically mentally ill.Hospital and Community Psychiatry, 40, 1041–1046.PubMedGoogle Scholar
  15. Evans, K., & Sullivan, J.M. (1990).Dual diagnosis: Counseling the mentally ill substance abuser. New York: Guilford.Google Scholar
  16. Fisher, J.D., & Fisher, W.A. (1992). Changing AIDS risk behavior.Psychological Bulletin, 111, 455–474.PubMedCrossRefGoogle Scholar
  17. Hall, R.C.W., Popkin, M.K., DeVaul, R., & Stickney, S.K. (1977). The effect of unrecognized drug abuse on diagnosis and therapeutic outcome.American Journal of Drug and Alcohol Abuse, 4, 455–465.PubMedCrossRefGoogle Scholar
  18. Hall, R.C.W., Stickney, S.K., Gardner, E.R., Perl, M., & LeCann, A.F. (1979). Relationship of psychiatric illness to drug abuse.Journal of Psychedelic Drugs, 11, 337–342.PubMedGoogle Scholar
  19. Institute of Medicine (1990).Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press.Google Scholar
  20. King, T.K., & DiClemente, C.C. (1993).A decisional balance measure for assessing and predicting drinking behavior. Poster presented at the Annual Meeting of the Association for Advancement vancement of Behavior Therapy, Atlanta, GA.Google Scholar
  21. Marlatt, G.A., & Gordon, J.R. (1985).Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford.Google Scholar
  22. Marlatt, G.A., & Tapert, S.F. (1993). Harm reduction: Reducing the risks of addictive behaviors. In J.S. Baer, G.A. Marlatt, & R.J. McMahon (Eds.).Addictive behaviors across the lifespan: Prevention, treatment, and policy issues. (pp. 243–273). Newbury Park, CA: Sage.Google Scholar
  23. Miller, W.R. (1985). Motivation for treatment: A review with special emphasis on alcoholism.Psychological Bulletin, 98, 84–107.PubMedCrossRefGoogle Scholar
  24. Miller, W.R., & Munoz, R. (1982).How to control your drinking: A practical guide to responsible drinking (Rev. Ed.). Albuquerque, NM: University of New Mexico Press.Google Scholar
  25. Miller, W.R., & Rollnick, S. (1991).Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.Google Scholar
  26. Minkoff, K. (1989). An integrated treatment model for dual diagnosis of psychosis and addiction.Hospital and Community Psychiatry, 40, 1031–1036.PubMedGoogle Scholar
  27. Minkoff, K. & Drake, R.E. (1991).Dual diagnosis of major mental illness and substance disorders. San Francisco: Jossey-Bass.Google Scholar
  28. Mueser, K.T., Yarnold, P.R., Levinson, D.F., Singh, H., Bellack, A.S., Kee, K., Morrison, R.L., & Yadalam, K.G. (1990). Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates.Schizophrenia Bulletin, 16, 31–56.PubMedGoogle Scholar
  29. Murray, D.M. & Perry, C.L. (1985). The prevention of adolescent drug abuse: Implications of etiological, developmental, behavioral, and environmental models. In C.L. Jones & R.J. Battles (Eds.).Etiology of drug abuse: Implications for treatment (DHHS Publication No. ADM 85-1335). Washington, DC: US Government Printing Office. 235–255.Google Scholar
  30. Nikkel, R.E. (1994). Areas of skill training for persons with mental illness and substance use disorders: Building skills for successful community living.Community Mental Health Journal, 30, 61–72.PubMedCrossRefGoogle Scholar
  31. Osher, F.C. & Kofoed, L.L. (1989). Treatment of patients with psychiatric and psychoactive substance abuse disorders.Hospital and Community Psychiatry, 40, 1025–1030.PubMedGoogle Scholar
  32. Pepper, B., Kirshner, M.C., & Ryglewicz, H. (1981). The young adult chronic patient: Overview of a population.Hospital and Community Psychiatry, 32, 463–469.PubMedGoogle Scholar
  33. Pristach, C.A., & Smith, C.M. (1990). Medication compliance and substance abuse among schizophrenic patients.Hospital and Community Psychiatry, 41, 1345–1348.PubMedGoogle Scholar
  34. Prochaska, J.O., & DiClemente, C.C. (1992). Stages of changes in the modification of problem behaviors. In M. Hersen, R.M. Eisler, & P.M. Miller (Eds.),Progress in behavior modification (pp. 184–218). Newbury Park, CA: Sage.Google Scholar
  35. Prochaska, J.O., Velicer, W.F., DeClemente, C.C., & Fava, J. (1988). Measuring processes of change: Application to the cessation of smoking.Journal of Consulting and Clinical Psychology, 56, 520–528.PubMedCrossRefGoogle Scholar
  36. Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., Judd, L.L., & Goodwin, F.K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse.Journal of the American Medical Association, 264, 2511–2518.PubMedCrossRefGoogle Scholar
  37. Richardson, M.A., Craig, T.J., & Haugland, G. (1985). Treatment patterns of young chronic schizophrenic patients in the era of deinstitutionalization.Psychiatric Quarterly, 57, 104–110.PubMedCrossRefGoogle Scholar
  38. Rosenberg, H. (1993). Prediction of controlled drinking by alcoholics and problem drinkers.Psychological Bulletin, 113, 129–139.PubMedCrossRefGoogle Scholar
  39. Rosenthal, R.N., Hellerstein, D.J., & Miner, C.R. (1992). A model of integrated services for outpatient treatment of patients with comorbid schizophrenia and addictive disorders.American Journal of Addictions, 1, 339–348.Google Scholar
  40. Safer, D.J. (1987). Substance abuse by young adult chronic patients.Hospital and Community Psychiatry, 38, 511–514.PubMedGoogle Scholar
  41. Solomon, P., & Davis, J.M. (1986). The effects of alcohol abuse among the new chronically mentally ill.Social Work in Health Care, 11, 65–74.PubMedCrossRefGoogle Scholar
  42. Test, M.A., Wallish, L.S., Allness, D.J., & Ripp, K. (1989). Substance use in young adults with schizophrenic disorders.Schizophrenia Bulletin, 15, 465–476.PubMedGoogle Scholar

Copyright information

© Human Sciences Press, Inc. 1996

Authors and Affiliations

  • Kate B. Carey
    • 1
  1. 1.Department of PsychologySyracuse UniversitySyracuse

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