Treatment of Substance Abusing Patients with Comorbid Psychiatric Disorders

Overview

Journal Addict Behav

Specialties Psychiatry
Social Sciences

Date 2011 Oct 11

PMID 21981788

Citations 71

Authors

Thomas M Kelly

Dennis C Daley

Antoine B Douaihy

Affiliations

Soon will be listed here.

Abstract

Objective: To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients.

Method: Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity.

Results: Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions.

Conclusions: Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.

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References

Hesse M . Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry. 2009; 9:6. PMC: 2657780. DOI: 10.1186/1471-244X-9-6. View

. Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997; 58(1):7-29. View

Saladin M, Drobes D, Coffey S, Dansky B, Brady K, Kilpatrick D . PTSD symptom severity as a predictor of cue-elicited drug craving in victims of violent crime. Addict Behav. 2003; 28(9):1611-29. DOI: 10.1016/j.addbeh.2003.08.037. View

Nunes E, McGrath P, Quitkin F, Stewart J, Koenig T, Wager S . Imipramine treatment of cocaine abuse: possible boundaries of efficacy. Drug Alcohol Depend. 1995; 39(3):185-95. DOI: 10.1016/0376-8716(95)01161-6. View

Nordstrom B, Levin F . Treatment of cannabis use disorders: a review of the literature. Am J Addict. 2007; 16(5):331-42. DOI: 10.1080/10550490701525665. View

Nunes E, Levin F . Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis. JAMA. 2004; 291(15):1887-96. DOI: 10.1001/jama.291.15.1887. View

Schade A, Marquenie L, van Balkom A, Koeter M, de Beurs E, van den Brink W . The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: a randomized controlled trial. Alcohol Clin Exp Res. 2005; 29(5):794-800. DOI: 10.1097/01.alc.0000163511.24583.33. View

Stulz N, Gallop R, Lutz W, Wrenn G, Crits-Christoph P . Examining differential effects of psychosocial treatments for cocaine dependence: an application of latent trajectory analyses. Drug Alcohol Depend. 2009; 106(2-3):164-72. PMC: 2814930. DOI: 10.1016/j.drugalcdep.2009.08.009. View

Dundon W, Pettinati H, Lynch K, Xie H, Varillo K, Makadon C . The therapeutic alliance in medical-based interventions impacts outcome in treating alcohol dependence. Drug Alcohol Depend. 2008; 95(3):230-6. PMC: 2600892. DOI: 10.1016/j.drugalcdep.2008.01.010. View

10.

Kampman K . What's new in the treatment of cocaine addiction?. Curr Psychiatry Rep. 2010; 12(5):441-7. DOI: 10.1007/s11920-010-0143-5. View

11.

Teesson M, Mills K, Ross J, Darke S, Williamson A, Havard A . The impact of treatment on 3 years' outcome for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Addiction. 2007; 103(1):80-8. DOI: 10.1111/j.1360-0443.2007.02029.x. View

12.

Miklowitz D, Otto M, Frank E, Reilly-Harrington N, Kogan J, Sachs G . Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. Am J Psychiatry. 2007; 164(9):1340-7. PMC: 3579578. DOI: 10.1176/appi.ajp.2007.07020311. View

13.

Zhang Z, Friedmann P, Gerstein D . Does retention matter? Treatment duration and improvement in drug use. Addiction. 2003; 98(5):673-84. DOI: 10.1046/j.1360-0443.2003.00354.x. View

14.

Geller B, Cooper T, Sun K, Zimerman B, Frazier J, Williams M . Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry. 1998; 37(2):171-8. DOI: 10.1097/00004583-199802000-00009. View

15.

Wobrock T, Soyka M . Pharmacotherapy of patients with schizophrenia and substance abuse. Expert Opin Pharmacother. 2009; 10(3):353-67. DOI: 10.1517/14656560802694655. View

16.

Barrowclough C, Haddock G, Wykes T, Beardmore R, Conrod P, Craig T . Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. BMJ. 2010; 341:c6325. PMC: 2991241. DOI: 10.1136/bmj.c6325. View

17.

Miklowitz D, Otto M, Frank E, Reilly-Harrington N, Wisniewski S, Kogan J . Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007; 64(4):419-26. PMC: 3579612. DOI: 10.1001/archpsyc.64.4.419. View

18.

Marsden J, Eastwood B, Bradbury C, Dale-Perera A, Farrell M, Hammond P . Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009; 374(9697):1262-70. DOI: 10.1016/S0140-6736(09)61420-3. View

19.

Garbutt J . The state of pharmacotherapy for the treatment of alcohol dependence. J Subst Abuse Treat. 2008; 36(1):S15-23. View

20.

Lybrand J, Caroff S . Management of schizophrenia with substance use disorders. Psychiatr Clin North Am. 2009; 32(4):821-33. DOI: 10.1016/j.psc.2009.09.002. View