CLINICAL HANDBOOK OF SCHIZOPHRENIA

44. Management of Co-Occurring Substance Use Disorders 469pressing current needs. Although some clients may require indefinite support, everyoneshould, of course, be offered opportunities to develop the maximum degree of culturallyappropriate adult functioning.KEY POINTS• Comorbidity of SUDs and serious mental disorders should be core business for mentalhealth services, because of its frequency and impact.• Current evidence favors integration of treatments for SUDs and serious mental disorder,provided by a single practitioner.• It is time to stop talking about dual diagnosis, and to recognize the complexity ofcomorbidities.• Relatively low levels of substance use can have substantial negative effects in people withserious mental disorders, and most people with this comorbidity do not have severe substancedependence.• Complex disorders do not necessarily imply more complex treatments: Clients and practitionersmay benefit maximally from strategies that have impact on multiple problems.• Although the evidence on effective treatments is still in its infancy, some potentially usefultreatments may be readily implemented by practitioners without substantial additional training.• As in other populations with substance use problems, people with serious mental healthdisorder may need several attempts to achieve sustained success in controlling substanceuse. We need to maintain our belief in ultimate success and help clients maintain their ownoptimism.REFERENCES AND RECOMMENDED READINGSGeneral reviews of comorbidity and its management are given by Donald, Dower, and Kavanagh(2005); Drake, Mercer-McFadden, Mueser, McHugo, and Bond (1998); Graham, Copello, Birchwood,and Mueser (2003); Kavanagh, Mueser, and Baker (2003); and Kavanagh and Mueser (2007).Castle and Murray (2004) offer an overview of the effects of cannabis, the use of cannabis by peoplewith psychosis, and the management of comorbidity with psychosis. Reviews of pharmacologicalmanagement of comorbidity are provided in Kavanagh, McGrath, Saunders, Dore, and Clark (2001)and Mueser, Noordsy, Drake, and Fox (2003). Reviews on effectiveness of brief interventions in generalpopulations with alcohol abuse or dependence are offered by Moyer, Finney, Swearingen, andVergun (2002) and Wilk, Jensen, and Havighurst (1997). Motivational interviewing is described andrelevant evidence is reviewed by Miller and Rollnick (2002). Methods to adapt motivational interviewingto serious mental disorder are in Martino, Carroll, Kostas, Perkins, and Rounsaville (2002).Start Over and Survive (SOS) is guided by a manual that is available on a link from http://www.uq.edu.au/coh. Select Online Psych.Castle, D., & Murray, R. (Eds.). (2004). Marijuana and madness. Cambridge, UK: Cambridge UniversityPress.Donald, M., Dower, J., & Kavanagh, D. J. (2005). Integrated versus non-integrated management andcare for clients with co-occurring mental health and substance use disorders: A qualitative systematicreview of randomised controlled trials. Social Science and Medicine, 60, 1371–1383.Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review ofintegrated mental health and substance abuse treatment for patients with dual disorders. SchizophreniaBulletin, 24, 589–608.Graham, H., Copello, A., Birchwood, M., & Mueser, K. T. (Eds.). (2003). Substance misuse in psychosis:Approaches to treatment and service delivery. Chichester, UK: Wiley.Kavanagh, D. J., McGrath, J., Saunders, J. B., Dore, G., & Clark, D. (2001). Substance abuse in patientswith schizophrenia: Epidemiology and management. Drugs, 62, 743–755.