Motivation to Quit Using Substances Among Individuals With Schizophrenia: Implications for a Motivation-based Treatment Model

Ziedonis, Douglas M.; Trudeau, Kimberlee J.

doi:10.1093/schbul/23.2.229

Cited by 158 publications

(94 citation statements)

References 31 publications

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“…Even persons admitted to alcohol and drug treatment programs vary in their level of motivation for change (DiClemente & Hughes, 1990; Project Match Research Group, 1997). Consistent with these findings, when Ziedonis and Trudeau administered a staging algorithm to 224 outpatient dually diagnosed with schizophrenia-spectrum and substance use disorders, they found that 50% were in the precontemplation stage with respect to changing their substance use behavior; 2% were in contemplation stage; 8% in preparation; 4% in action; and 36% in maintenance (Ziedonis & Trudeau, 1997). Thus low levels of motivation for changing substance use behavior can be observed within a variety of treatment settings.…”

Section: Introductionmentioning

confidence: 76%

“…The cross-sectional nature of these data precludes inferences about temporal relations among these variables (i.e., the strong concurrent correlations observed among theoretically-related variables do not address the extent to which manipulating one might cause changes in another). Authors describing motivation enhancement interventions for this population have suggested that increasing a person's awareness of the cons of using, or the benefits of quitting, may result in greater recognition of substance use problems and likelihood of taking steps (Carey, 1996;Mercer, Mueser, & Drake, 1998;Ziedonis & Trudeau, 1997), however, longitudinal or experimental evidence for this relationship is needed.…”

Section: Discussionmentioning

confidence: 99%

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Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

et al. 2001

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Objective-The high rates of comorbid substance use disorders among persons living with severe and persistent mental illness (SPMI) have increased interest in assessing and enhancing motivation to change substance misuse in this population. This study provides evidence for the psychometric adequacy of three self-report measures of readiness-to-change.Method-The sample consisted of 84 persons (65% men) with co-occurring substance abuse or dependence and an SPMI. After a psychiatric assessment, participants completed three measures of readiness-to-change, which yielded seven subscales: (1) the Stages of Change Readiness and Treatment Eagerness Scale (ambivalence about change, recognition of substance-related problems, taking steps), (2) Decisional Balance Scale (pros of using, cons of using) and (3) the Alcohol and Drug Consequences Questionnaire (costs of quitting, benefits of quitting).Results-All of the subscales were stable over time, and 6 of the 7 subscales demonstrated excellent internal consistency. Reliability indices were comparable when analyses were repeated on subsets of participants defined by diagnosis, cognitive function, positive symptoms and negative symptoms. A pattern of theoretically meaningful intercorrelations provided convergent evidence of validity, and a general lack of relationships with demographic variables and indices of psychiatric status provided discriminant evidence of validity. These findings support efforts to quantify readiness-to-change substance misuse among persons with an SPMI.Substance use disorders are highly prevalent among persons with schizophrenia and other major mental illnesses. Persons with major (Axis I) mental disorders have three times the risk of drug or alcohol diagnoses compared to the rest of the population (Regier et al., 1990). Persons with schizophrenia represent a particularly high risk group for problems related to substance use. Among all persons with a diagnosis of schizophrenia, 47% meet lifetime criteria for a substance use disorder (Regier et al., 1990). This prevalence rate is often higher in samples of schizophrenic patients in treatment (Mueser et al., 1990;Test, Wallisch, Allness, & Ripp, 1989).A diagnosis of substance abuse or dependence impairs both the process and outcome of mental health treatment. Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al., 1995;Shaner et al., 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985). This pattern of poor treatment compliance and exacerbated symptoms leads ...

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Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

et al. 2001

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“…Despite the lack of unequivocal evidence for an efficient model for managing substance use in severe mental illness, motivational interviewing techniques, community reinforcement approaches, assertive case management, and a blend of standard psychological interventions for substance use with specific pharmacotherapies have each proven successful in extending abstinence (Ziedonis 1997;Brunette 2006a). …”

Section: How Successful Are These Models?mentioning

confidence: 99%

Managing cannabis use in people with severe mental illness: what can be done?

Atakan¹

2009

Adv. psychiatr. treat

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SummaryNearly half of people with severe mental illness use cannabis sometime in their lives and during their illness. Its use can have multiple and severe consequences for the course of the illness. Despite the significance of the problem, managing cannabis use in this group is a recently developing topic and is still in its infancy. This article reviews the current state of knowledge on the management of people with severe mental illness who continue to use cannabis, specifically focusing on different models of service provision, and psychological and pharmacological interventions.

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“…The intervention blends relapse prevention, social skills training, motivational enhancement therapy, and the "recovery language" of Twelve-Step Therapy 12,13 . In a number of trials, DRT has contributed to significant improvements in psychiatric and substance abuse outcomes and to better treatment adherence 12,14 . The DRT approach was not modified from the original format for the first six weeks of the TLC intervention.…”

Section: Dual Recovery Therapymentioning

confidence: 99%

“…The DRT approach was not modified from the original format for the first six weeks of the TLC intervention. This segment of DRT emphasized motivational enhancement techniques that promote treatment engagement and compliance to minimize the recidivism common among people with co-morbid disorders 12,14 . The remaining two weeks of the eight-week DRT component delivered through TLC is modified from the original format and focused on relapse prevention techniques and psycho-educational skills.…”

Section: Dual Recovery Therapymentioning

confidence: 99%

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

et al. 2007

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-Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention.Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service.Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up.Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should Background and Objectives

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Motivation to Quit Using Substances Among Individuals With Schizophrenia: Implications for a Motivation-based Treatment Model

Cited by 158 publications

References 31 publications

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

Managing cannabis use in people with severe mental illness: what can be done?

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

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