Psychosocial interventions for co-occurring schizophrenia and substance use disorder
- E Cabrina Campbell, MD
E Cabrina Campbell, MD
- Associate Professor of Psychiatry
- Perelman School of Medicine, University of Pennsylvania; Cpl. Michael J. Crescenz VA Medical Center
- Stanley N Caroff, MD
Stanley N Caroff, MD
- Emeritus Professor of Psychiatry
- Perelman School of Medicine, University of Pennsylvania
- Stephan C Mann, MD, DLFAPA
Stephan C Mann, MD, DLFAPA
- Lenape Valley Foundation
- Section Editors
- Andrew J Saxon, MD
Andrew J Saxon, MD
- Section Editor — Substance Use Disorders
- Professor and Director, Addiction Psychiatry Residency Program, Department of Psychiatry & Behavioral Sciences
- University of Washington
- Stephen Marder, MD
Stephen Marder, MD
- Section Editor — Psychotic Disorders
- Professor of Psychiatry
- Semel Institute of Neuroscience at UCLA
Schizophrenia and addiction are both chronic disorders with serious complications, consequences, and costs for individuals and society. These conditions, which are also known as “dual diagnoses,” are associated with poor adherence to treatment and poorer outcomes when the co-occurring disorder is present.
Some of the symptoms of schizophrenia overlap with symptoms of intoxication, chronic use, or withdrawal from alcohol or other drugs. Family history and the temporal relationship of symptoms can help to distinguish patients with a substance use disorder (SUD) alone from co-occurring schizophrenia and SUD.
The psychiatric diagnoses in DSM-IV-TR, substance abuse and substance dependence, were replaced by one diagnosis, SUD, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to SUD, moderate to severe subtype, while substance abuse is similar to the mild subtype.
Psychosocial interventions for patients with co-occurring schizophrenia and SUD are described here. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and pharmacotherapy for co-occurring schizophrenia and SUD are described separately. Psychosocial interventions for schizophrenia occurring alone and specific substance use disorders occurring alone are also discussed separately. (See "Co-occurring schizophrenia and substance use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis" and "Pharmacotherapy for co-occurring schizophrenia and substance use disorder" and "Psychosocial interventions for schizophrenia" and "Psychosocial interventions for opioid use disorder" and "Psychosocial treatment of alcohol use disorder" and "Psychosocial interventions for stimulant use disorder in adults".)
Treatment for co-occurring schizophrenia and substance use disorder (SUD) typically involves a combination of psychosocial intervention(s), described here, and pharmacotherapy, described separately. There is wide variability across the United States and internationally in the availability and content of psychosocial interventions for these disorders. In addition to the psychosocial interventions described here, treatment of SUD generally includes addiction counseling or psychotherapy. (See "Pharmacotherapy for co-occurring schizophrenia and substance use disorder" and "Continuing care for addiction: Implementation", section on 'Addiction counseling'.)
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- INDIVIDUAL INTERVENTIONS
- - Skills training
- - Family-based educational intervention
- - Assertive community treatment
- Substance use disorders
- - Motivational interviewing
- - Mutual help groups
- - Contingency management
- Schizophrenia and SUD
- - Modified CBT
- MULTIMODAL INTERVENTIONS
- SUMMARY AND RECOMMENDATIONS