Although estimates of the prevalence of substance use disorders vary by population, a higher prevalence among persons with severe mental illness has been confirmed. Routine screening for and assessment of substance use disorders among persons with severe mental illness has become the accepted standard of care. The course of severe mental illness is negatively influenced by a substance use disorder, and an integrated approach to the treatment of both disorders is generally accepted to be the most promising treatment strategy. Components of this strategy include harm reduction, treatment in stages, motivational interviewing, cognitive-behavioral interventions, and modified 12-step self-help groups.

The BJMHS is a practical, efficient tool that jail correction officers can give male detainees on intake screening. However, the screen has an unacceptably high false-negative rate for female detainees.

This review examines the impact of assertive community treatment (ACT) and case management models on the use of inpatient hospitalization and other community mental health services, costs, and other clinical and social outcomes. ACT programs have been found to reduce hospitalization and increase use of community mental health services at an equivalent or reduced cost. Greater fidelity to the ACT model produced better outcomes. The impact of case management models is less consistent, but intensive case management programs also have been found to reduce hospitalization. We discuss limitations in past research and recommend future directions.

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A minority of families of persons with schizophrenia receive information about the illness from providers. Implementation of model family interventions is possible with considerable technical assistance. A gap exists between best practices and standard practices for families of persons with schizophrenia.

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This review examines the impact of dynamic and supportive psychotherapies (both individual and group) and psychosocial skills training on clinical and social outcomes for individuals with schizophrenia. The relatively few controlled trials of individual or group psychotherapies for persons with schizophrenia exhibit serious methodological problems that limit their generalizability. Reality-oriented approaches appear to be superior to dynamic, insight-oriented psychotherapies, but further research is needed to identify and evaluate disorder-specific models that target specific deficits and disabilities in schizophrenia. Research on psychosocial skills training models shows that target skills can be trained and maintained over time. Further work is needed to determine the extent to which trained skills generalize from the original training setting to "real life" environments.

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