Treating substance abuse alone helps patients with co-occurring psychosis

By Liam Davenport, medwireNews Reporter

Patients with co-occurring substance use disorder and psychiatric disorders (SUD-PSY) may benefit from standard substance use disorder treatment, with the effects potentially lasting for several years, the results of a US study indicate.

The study included 236 male patients with SUD who were also diagnosed with a non-substance-related psychotic disorder. In all, 62.7% of patients were diagnosed with schizophrenia, while 37.3% were diagnosed with schizoaffective disorder.

The patients were enrolled in either a 12-step facilitation or cognitive-behavioral orientated treatment program that lasted between 21 and 28 days. Patients completed a series of assessments at discharge from medical detoxification, and at 1- and 5-year follow-up.

The team reports in Schizophrenia Research that patients showed improvements in proximal outcomes at discharge, such as quitting and self-efficacy, scores for which increased from 2.91 to 3.41 points out of a possible 5.00 points. In addition, patients' approach to coping improved significantly, with an increase in scores from 20.65 to 27.67 points out of 36.00, while scores for avoidant coping decreased, from 17.77 to 13.38 points out of 36.00.

Patients who perceived greater support, spontaneity, spirituality, and personal problem orientation from the treatment program showed generally better proximal outcomes, particularly with regard to self-efficacy and approach coping. The strongest predictor for outcome was treatment satisfaction. Furthermore, patients who perceived more support were more likely to attend outpatient treatment and 12-step self-help groups.

Patients also improved on 1-year and 5-year outcomes, with significant decreases in psychiatric symptoms, as rated on the Brief Symptom Inventory, with scores down from 1.94 at baseline to 1.66 and 1.63 out of 4.00 at 1 and 5 years, respectively, and substance use frequency, with patient rating scores decreasing from 7.57 to 3.36 and 3.38 out of 68.00, respectively. Patients who had better proximal outcomes at discharge tended to have fewer psychiatric symptoms and less substance use at 1 year, and those who participated in 12-step programs tended to experience better 1-year employment outcomes and both 1-year and 5-year substance use outcomes.

Authors Matthew Tyler Boden and Rudolf Moos, from the Center for Health Care Evaluation in Menlo, California, comment: "Although experts are consistent in their recommendations for treating SUD-PSY patients with an integrated approach, and integrated approaches are effective, our results suggest that SUD-PSY patients may benefit from standard SUD treatments, even those that may not directly address their psychiatric disorders.

"These findings are notable given that many SUD-PSY patients, such as veterans receiving care through the Department of Veterans Affairs, do not receive integrated treatments."

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