Treatment of substance abusing patients with comorbid psychiatric disorders

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.

Comorbidities of mental and behavioral disorders in chemically dependent patients in different periods of abstinence

“…Diagnosing CMBD in SUD patients is important because it enables both disorders to be treated. This treatment can be performed sequentially, simultaneously or in an integrated way, depending on the type and severity of the two disorders [3][4][5] .…”

Educação Em Saúde Com Pessoas Usuárias De Álcool E Outras Drogas

“…Indivíduos que fazem uso e abuso de substâncias psicoativas têm maior probabilidade de desenvolver algum transtorno mental (25) . Quando apresentam comorbidade, como transtornos mentais, a psicoterapia tem demonstrado resultados positivos, quando combinada com a farmacoterapia (26) .…”

Recovery From Comorbidity

“…This approach is challenging to generalize to the nebulous and fluid variables, interactions, timeframes, sociocultural subtleties, and individualization inherent in comorbidity (Kelly, Daley, & Douaihy, 2012;Kessler, 2004a;Thylstrup & Johansen, 2009;Tracy & Johnson, 2007).…”

“…There is uncertain evidence of the role of antidepressant therapies in alcohol and depression comorbidity, even with short-term outcomes, with many studies involving patients receiving multiple treatment modalities concomitantly (ovieno et al, 2011;Kelly et al, 2012;Le Fauve et al, 2004;Nunes & Levin, 2004;Pettinati et al, 2010;Tiet & Mausbach, 2007;Torrens et al, 2005). Benefits to depression outcomes may be greater than alcohol-related outcomes, but these are of low impact and needing replication (Nunes & Levin, 2004;Tiet & Mausbach, 2007;Watkins et al, 2005).…”