Ten-Year Recovery Outcomes for Clients With Co-Occurring Schizophrenia and Substance Use Disorders

Drake, Robert E.; McHugo, Gregory J.; Xie, Haiyi; Fox, Melinda B.; Packard, Joan; Helmstetter, Barbara S.

doi:10.1093/schbul/sbj064

Cited by 124 publications

(88 citation statements)

References 49 publications

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“…The term recovery as such has different meanings [12] but abstinence is a common point for all of these researches [13]. Exploring the relationship that Jung accounted in his correspondence with Bill [1], many authors have suggested spirituality as an important motivator for recovery in substance-dependent people [14,15], and it is a concept that operates in a twelve-step recovery process [16,17,18,[19][20][21]22].…”

Section: Relevant Findings On Spirituality and Its Importance For Recmentioning

confidence: 99%

Spiritus contra Spiritum: Including Spirituality in Addiction Treatments for Recovery, a Systematic Review

Garcia¹,

Babarro²,

Toldos-Romero³

2017

ujp

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Spirituality had been acknowledged as a key construct to observe in the treatment and recovery from addictions. Due to the individualistic nature of the construct and overlap with religion, it is still not clear how spirituality influence treatment and recovery of individuals. Different treatments and approaches like AA philosophy or spiritual practices embrace the whole construct to obtain better outcomes in recovery for addictions. The aim of this review was to examine the effects of this construct and its relationship with recovery. A search strategy was followed to retrieve 457 scientific papers related with the matter of study. A total of 14 studies were selected and assessed for quality. Experimental and observational studies were categorised by design, and reviewed through narrative synthesis. Results showed that due to the lack of experimental research, poor quality and diverse conceptions of the construct, spiritual treatments are not more effective than other treatments whereas high levels of spirituality and spiritual practices tend to reduce the substance use outcomes and improve in other areas of recovery. From the findings reviewed which need to be considered with caution, it was concluded that implementing this construct within the therapy or approach may improve, in many cases, to achieve a successful recovery. More research is needed to determine if spiritual-related treatments have better outcomes, and some recommendations were addressed for future research, in addition to an encouragement for the inclusion of spirituality with its diversity into different domains of clinical practice.

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Section: Relevant Findings On Spirituality and Its Importance For Recmentioning

confidence: 99%

Spiritus contra Spiritum: Including Spirituality in Addiction Treatments for Recovery, a Systematic Review

Garcia¹,

Babarro²,

Toldos-Romero³

2017

ujp

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“…60 This approach integrates more of the elements of service user-defined recovery such as a range of life domains and individual values. 61 Measures such as the Global Assessment of Functioning (GAF 62 ) scale and the Quality of Life Scale 63 are commonly used. Research studies often use these measures alongside the more traditional symptom and relapse measures.…”

Section: Introductionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Research from different treatment settings indicate that 30 per cent of those with less severe mental illness and heavy substance use attain sustained remission [22], whereas up to 60 per cent of those with SMI and less severe substance use attain sustained remission [23,24].…”

Section: Introductionmentioning

confidence: 99%

Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use

Pettersen

Ruud²,

Ravndal³

et al. 2014

J Addict Res Ther

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Individuals diagnosed with severe mental illness (SMI) are more vulnerable to substances than are other people. Many people with SMI tend to attain full remission of their substance use, but others relapse frequently. There is more research on the reasons for substance use than on the reasons for abstaining among these individuals. Information from the latter may contribute to a better understanding of how individuals with SMI experience abstaining from substance use. Objective: The aim of this explorative study was to examine experiences of abstaining from substances of persons diagnosed with SMI. We examined both the reasons given and the requirements and strategies used when abstaining. Methods:A qualitative study with semi-structured interviews was conducted, and a descriptive and explorative design was applied. This study included a purposeful sample of 11 patients with SMI and substance use being treated by assertive community treatment teams. Results:The main reasons for quitting substance use were social relationships and meaningful activities. The stated requirements and strategies used in the search for sobriety were detachment towards people and places, positive thinking, controlling feelings and emotions, and fear of dependency. Conclusion:Our results are consistent with those from other qualitative studies on the importance of social relationships and meaningful activities as expressed reasons for abstaining. The strategy of actively avoiding a former adverse milieu to reach sobriety is consistent with findings from one similar study. The strategies of fear of adverse consequences, positive thinking, and controlling feelings and emotions found in the present study have not been reported by other qualitative studies.

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Ten-Year Recovery Outcomes for Clients With Co-Occurring Schizophrenia and Substance Use Disorders

Cited by 124 publications

References 49 publications

Spiritus contra Spiritum: Including Spirituality in Addiction Treatments for Recovery, a Systematic Review

Spiritus contra Spiritum: Including Spirituality in Addiction Treatments for Recovery, a Systematic Review

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use

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