An integrated substance use treatment model for young adults with first‐episode psychosis: A naturalistic pilot evaluation

Abstract

Aim Approximately 50% of individuals with first‐episode psychosis meet criteria for a substance use disorder and these concurrent disorders are associated with worse long‐term outcomes. Psychosocial interventions, including motivational interviewing as well as cognitive and behavioural therapies, have shown some evidence for effective treatment in substance use disorders; however, there is a paucity of existing studies that have successfully examined these interventions in first‐episode psychosis. Methods Participants (n = 64) received the concurrent disorders intervention, which included individual support alongside participation in at least one of two groups: a 4‐week Motivational Engagement group utilizing motivational interviewing (n = 59) and an 8‐week Relapse Prevention Training group emphasizing skill acquisition, which some participants entered directly (n = 5) and some participants entered following completion of the Motivational Engagement group (n = 16). Results Participants who completed the Motivational Engagement group (n = 59) demonstrated significantly increased motivation to change substance use (d = −.0.58; t = −3.02, p < .01) and significantly decreased substance use frequency (d = 0.65; t = 3.26, p < .01). For participants who completed the Relapse Prevention Training group (n = 21), substance use frequency significantly decreased (d = 0.92; t = 3.46, p < .01) and self‐efficacy in one's ability to maintain substance use changes significantly increased (d = −0.85; t = −3.59, p < .01). Conclusions This pilot evaluation suggests that motivational interviewing and relapse prevention skills training are acceptable and feasible interventions in the treatment of substance use disorders in young adults with first‐episode psychosis.

Motivational Interviewing Interventions for Harmful Substance Use Amongst Adults in Low- and Middle-Income Countries (LMICs): A Systematic Review

“…In this review, MI interventions showed significant reductions in substance use and other associated health benefits in seven of the 11 included studies [32, 34, 36-38, 41, 42]. These findings were consistent with results found in HICs [9,[18][19][20][21][22]. There are various potential reasons why the remaining four studies [33,35,39,40] yielded less favourable outcomes.…”

“…The impact of MI as a strategy for addressing substance use in HICs is generally favourable, although it has yielded varied outcomes [9,[18][19][20][21][22][23][24]. However, there is far less evidence to support its effectiveness in LMICs.…”

“…The effectiveness of MI as an intervention for substance use in HICs is mainly positive but has also produced mixed results. Studies from HICs show that MI results in improved outcomes for non- injection drug users [9] with AUDs [18] improved treatment response [19], for co-occurring alcohol use and depression [20, 21] and has been found to be effective in the treatment of first episode psychosis and SUDs in young adults [22]. However, in a meta-analysis by Wang and colleagues [23] the use of pure MI to treat psychosis and SUDs was found to be varied with relatively modest positive outcomes.…”

Primary and Secondary Prevention in Delusional Disorder

“…Substance use disorder is a further important co-morbidity that, when treated, can prevent or reduce the severity of DD, as has been demonstrated in patients with first-episode psychosis. 53 de Portugal et al, using DSM-IV-TR criteria, carried out a cross-sectional…”

Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions

“…Continuing SUD for young adults enrolled in CSC was associated with stopping services, poorer life skills, worse symptoms, and lower rates of medication adherence (Oluwoye et al, 2019; Patel et al, 2016; Schoeler et al, 2017), as well as decreased ‘graduation’ rates (Fraser et al, 2023). Outside of CSC, one intervention for young adults with EP that used motivational interviewing techniques and relapse prevention skills training that prioritized skill acquisition was found to significantly increase young persons' motivations to decrease use frequency (Herman et al, 2022). Additionally, Bello and Dixon (2022) highlight the use of integrated mental health and substance use interventions as best practice for EP.…”