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Trans-sector integrated treatment beneficial for individuals with psychosis, addiction

Low-threshold, motivational, integrated treatment programs with psychoeducative and behavioral therapeutic elements may be useful to treat individuals with a dual diagnosis of schizophrenia and addiction, according to recent findings.

“Patients with schizophrenic psychosis and a comorbid addiction disorder account for about 50% (lifetime prevalence) and 25% to 30% (6-month prevalence) of all patients with psychosis,” Euphrosyne Gouzoulis-Mayfrank, MD, of the University of Cologne, Köln, Germany, and colleagues wrote. “Primarily because of their relatively poor compliance, dual diagnosis patients are regarded as difficult to treat. They often encounter therapeutic nihilism from health professionals… Measures that have been described as successful in the long term are motivational, low-threshold programs that were conceived for a longer period and include psychoeducational, behavioral therapeutic, and occasionally family therapy elements.”

To assess efficacy and feasibility of integrated treatment for psychosis and addiction, researchers conducted a single-center, randomized controlled trial among 100 patients with dual diagnosis. Study participants randomly assigned to the intervention group were admitted to a specialized open hospital ward and given integrated treatment, including disorder-specific therapy which continued in the subsequent outpatient phase. Participants assigned to the control group were admitted to an open general psychiatric ward and received treatment as usual with no disorder-specific treatment.

The intervention group developed higher abstinence motivation (P = .009) and had greater reductions in substance use (P = .039 at 3 months) compared with the control group.

Participants in the intervention group were more satisfied with their treatment overall (P = .011). They also exhibited higher global levels of functioning and retention rates compared with the control group, but these did not reach statistical significance.

“The study results allow the conclusion that the widespread therapeutic nihilism regarding dual diagnosis patients is not justified. Long-term, motivational, psychosocial treatment programs have the potential to affect outcomes positively. However, the study also shows that it is not great therapeutic expectations that should be pursued but, rather, moderate aims in the sense of harm reduction approaches,” Gouzoulis-Mayfrank and colleagues wrote. “In parallel, integrated programs should be more widely implemented as part of standard care, and these should be developed further. Setting up special self-help groups among dual diagnosis patients (‘double trouble groups’) would be highly desirable, as would the inclusion of promising family therapy elements.” – by Amanda Oldt

Disclosure: Gouzoulis-Mayfrank reports receiving author fees for book publications on the subject of comorbidity, psychosis, and addiction from Springer, Kohlhammer, and Steinkopff, and conference delegate fees, reimbursement of travel expenses and lecture fees from Bristol-Myers Squibb, Servier, Otsuka, Janssen Cilag, Astra Zeneca, and Pfizer. Please see the full study for a list of all authors’ relevant financial disclosures.