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".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series, National Academies Press, Washington DC 2006. p.210.
- Mueser KT, Gingerich S. Treatment of co-occurring psychotic and substance use disorders. Soc Work Public Health 2013; 28:424.
- Hunt GE, Siegfried N, Morley K, et al. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2013; :CD001088.
- Kurtz MM, Mueser KT. A meta-analysis of controlled research on social skills training for schizophrenia. J Consult Clin Psychol 2008; 76:491.
- Barrowclough C, Haddock G, Tarrier N, et al. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 2001; 158:1706.
- Mueser KT, Glynn SM, Cather C, et al. A randomized controlled trial of family intervention for co-occurring substance use and severe psychiatric disorders. Schizophr Bull 2013; 39:658.
- Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev 2010; :CD000088.
- Dixon LB, Dickerson F, Bellack AS, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010; 36:48.
- Morse GA, Calsyn RJ, Dean Klinkenberg W, et al. Treating homeless clients with severe mental illness and substance use disorders: costs and outcomes. Community Ment Health J 2006; 42:377.
- Himelhoch S, Lehman A, Kreyenbuhl J, et al. Prevalence of chronic obstructive pulmonary disease among those with serious mental illness. Am J Psychiatry 2004; 161:2317.
- Brunette MF, Mueser KT. Psychosocial interventions for the long-term management of patients with severe mental illness and co-occurring substance use disorder. J Clin Psychiatry 2006; 67 Suppl 7:10.
- Smedslund G, Berg RC, Hammerstrøm KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011; :CD008063.
- Miller WR, Zweben A, DiClemente CC, Rychtarik RC. Motivational Enhancement Therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Vol. Project MATCH Monograph Series, National Institute on Alcohol Abuse and Alcoholism, Rockville 1992. Vol 2.
- Ziedonis DM, Stern R. Dual recovery therapy for schizophrenia and substance abuse. Psychiatr Ann 2001; 31:255.
- Graeber DA, Moyers TB, Griffith G, et al. A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. Community Ment Health J 2003; 39:189.
- Monica C, Nikkel RE, Drake RE. Alcohol & drug abuse: Dual Diagnosis Anonymous of Oregon. Psychiatr Serv 2010; 61:738.
- Magura S. Effectiveness of dual focus mutual aid for co-occurring substance use and mental health disorders: a review and synthesis of the "Double Trouble" in Recovery evaluation. Subst Use Misuse 2008; 43:1904.
- Green CA, Yarborough MT, Polen MR, et al. Dual recovery among people with serious mental illnesses and substance problems: a qualitative analysis. J Dual Diagn 2015; 11:33.
- Roush S, Monica C, Carpenter-Song E, Drake RE. First-Person Perspectives on Dual Diagnosis Anonymous (DDA): A Qualitative Study. J Dual Diagn 2015; 11:136.
- Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev 2006; :CD005032.
- McDonell MG, Srebnik D, Angelo F, et al. Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness. Am J Psychiatry 2013; 170:94.
- Tracy K, Babuscio T, Nich C, et al. Contingency Management to reduce substance use in individuals who are homeless with co-occurring psychiatric disorders. Am J Drug Alcohol Abuse 2007; 33:253.
- Lussier JP, Heil SH, Mongeon JA, et al. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction 2006; 101:192.
- Kuller AM, Ott BD, Goisman RM, et al. Cognitive behavioral therapy and schizophrenia: a survey of clinical practices and views on efficacy in the United States and United kingdom. Community Ment Health J 2010; 46:2.
- Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009; 70:516.
- Jauhar S, McKenna PJ, Radua J, et al. Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry 2014; 204:20.
- De Witte NA, Crunelle CL, Sabbe B, et al. Treatment for outpatients with comorbid schizophrenia and substance use disorders: a review. Eur Addict Res 2014; 20:105.
- Bellack AS, Bennett ME, Gearon JS, et al. A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Arch Gen Psychiatry 2006; 63:426.
- Shaner A, Eckman T, Roberts LJ, Fuller T. Feasibility of a skills training approach to reduce substance dependence among individuals with schizophrenia. Psychiatr Serv 2003; 54:1287.
- James W, Preston NJ, Koh G, et al. A group intervention which assists patients with dual diagnosis reduce their drug use: a randomized controlled trial. Psychol Med 2004; 34:983.
- Hjorthøj CR, Fohlmann A, Larsen AM, et al. Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial. Psychol Med 2013; 43:1499.
- Hjorthøj CR, Orlovska S, Fohlmann A, Nordentoft M. Psychiatric treatment following participation in the CapOpus randomized trial for patients with comorbid cannabis use disorder and psychosis. Schizophr Res 2013; 151:191.
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS