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Integrated therapy
earns support
(August/September
2005 Issue)
By Ami Albernaz
Integrated therapy for mental illness and substance abuse, already
in favor among many clinicians, has received additional support
from a study conducted by researchers at Dartmouth Medical School
in N.H.
The researchers reported in the journal "Schizophrenia Research"
that patients with co-occurring schizophrenia or schizoaffective
disorder and substance abuse problems improved steadily when they
received integrated treatment over the course of three years. The
measures for which improvement was noted included control of schizophrenia
symptoms, decrease in substance use, finding work and increased
social contacts with non-substance abusers.
The 152 patients evaluated were part of the broader New Hampshire
Dual Diagnosis Study, in which patients with mental illness and
substance use disorders received treatment for both conditions from
one team of clinicians. While outcomes for dual disorder integrated
treatment had been shown effective for substance abuse concurrent
with other mental illnesses such as bipolar disorder, little was
known about the expected outcomes for schizophrenia, the team wrote.
Compared to the general population, the proportion of substance
abusers among people with schizophrenia or other schizoaffective
disorders is abnormally high - around 50 percent. Robert E. Drake,
M.D., Ph.D., a co-author of the Dartmouth study who helped develop
the integrated dual disorder treatment model, says treatment that
targets both issues makes sense.
"If you refer a person to two different treatment models, they
get two different messages," he says. Many patients undergoing parallel
treatment are unable to integrate the two messages and drop out
of treatment as a result, he adds.
Providers of integrated treatment could prescribe medications that
seem effective for both schizophrenia and substance abuse problems.
In the context of teaching patients social skills, clinicians might
address making friends who are not substance users. Each intervention
that would be taken for treating schizophrenia is adjusted to address
substance use disorder, Drake says.
Despite the encouraging results of the Dartmouth study and the
improvements made on most measures, the patients did not, overall,
spend more time in independent living situations. The team noted
that this result is consistent with the finding that some people
with co-occurring disorders seek out more structured environments
with others who are also trying to abstain from substance use.
Still, Drake says, the overall picture is promising enough that
integrated treatment is being implemented on a wider scale. And,
patients who continue to receive this treatment longer term seem
to keep improving. Drake and his colleagues recently examined 10-year
outcomes of integrated treatment patients. "People continue to do
better and better," he says.
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