CLINICAL HANDBOOK OF SCHIZOPHRENIA

154 II. ASSESSMENT AND DIAGNOSISor Narcotic Anonymous may be helpful for some patients, available data suggest thatoutcomes are better for patients in programs that integrate mental health and substanceabuse treatments. Successful treatments address motivational issues and teach individualshow to develop skills for recovery. A relatively new treatment that has shown promise forthis group of patients, called behavioral treatment for substance abuse in schizophrenia,involves motivational interviewing to develop treatment goals; urinalysis contingency, inwhich social and small monetary reinforcement are provided for “clean” urine; socialskills training aimed at providing patients the skills necessary to refuse drugs whenoffered and to develop friendships with those who do not use drugs; education aboutmedications for psychiatric illness and how drugs affect the brain; and learning to copewith high-risk situations. This treatment has been found to decrease patients’ substanceuse and increase the frequency of “clean” urine drug screens.Additional common problems for individuals with schizophrenia include comorbiddepression, anxiety, posttraumatic stress and obsessive–compulsive symptoms. Cognitivebehavioralapproaches have been found to be effective with each of these syndromes inpersons without schizophrenia. While it seems reasonable to extrapolate from these studiesthat this approach is efficacious in schizophrenia, studies to demonstrate this are lacking.Evidence is mixed for the usefulness of CBT for the treatment of depression associatedwith psychotic symptoms.KEY POINTS• Treatment plans should match specific treatments with individual needs and goals.• Treatments are more successful when the individual participates in developing his or hertreatment plan.• Treatment plans should prioritize based on the urgency, criticality, and feasibility of specifictreatment goals.• Documentation of interventions and of their effects is critical to making rational changes inthe treatment plan.• The range of evidence-based practices and promising new treatments permits the creationof treatment plans that comprehensively address symptoms and problems in daily functioningin schizophrenia.REFERENCES AND RECOMMENDED READINGSAmerican Psychiatric Association. (2004). Practice guideline for the treatment of patients with schizophrenia(2nd ed.). Washington, DC: Author.Bond, G. R. (2004). Supported employment: Evidence for an evidence-based practice. Psychiatric RehabilitationJournal, 27, 345–359.Bell, M., Bryson, G., Greig, T., Corcoran, C., & Wexler, B. E. (2001). Neurocognitive enhancementtherapy with work therapy: Effects on neuropsychological test performance. Archives of GeneralPsychiatry, 58(8), 763–768.Bellack, A. S. (2004). Skills training for people with severe mental illness. Psychiatric RehabilitationJournal, 27(4), 375–391.Bennett, M. E., Bellack, A. S., & Gearon, J. S. (2001). Treating substance abuse in schizophrenia: Aninitial report. Journal of Substance Abuse Treatment, 20(2), 163–175.Dolder, C. R., Lacro, J. P., Leckband, S., & Jeste, D. V. (2003). Interventions to improve antipsychoticmedication adherence: Review of recent literature. Journal of Clinical Psychopharmacology,23(4), 389–399.Drake, R., & Mueser, K. T. (2000). Psychosocial approaches to dual diagnosis. Schizophrenia Bulletin,26, 105–118.