Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

12. Co-Occurring Substance Use Disorders and Other Psychiatric Disorders 281Severely and Persistently Mentally Ill PopulationsSeveral investigators have examined integrated treatments for SPMI adults.Effectiveness trials by Drake and colleagues have obtained more success indecreasing substance use (Drake et al., 1998; McHugo, Drake, Teague, & Xie,1999) and hospitalization (McHugo et al., 1999) than in diminishing psychiatricsymptoms (Drake, Yovetich, Bebout, Harris, & McHugo, 1998; Drake et al.,1998) or improving functional status or quality of life (Drake et al., 1997).However, these interventions did not compare patients randomized to differenttreatments. Rather, treatment clinics were assigned to administer one interventionversus another. A recent review of the prospective, controlled trials ofintegrated treatment programs for SPMI dually diagnosed individuals (Jeffery,Ley, McLaren, & Siegfried, 2003) concluded that methodological flaws precludeddetermining whether one particular integrated treatment model is moreeffective than another, or whether integrated treatment in general is superior tononintegrated treatment for this population. Despite this, much enthusiasmremains for integrated treatment in SPMI populations (Drake et al., 2001). Ofnote, a recent trial not included in the review approached integrating treatmentfor dually diagnosed SPMI patients from a different psychosocial treatmentperspective and found positive results. Rather than integrating treatmentfrom the perspective of intensive case management and/or housing (as in thestudies discussed earlier), patient and caregiver dyads were randomized to routinecare versus additional integrated treatment that included motivationalinterviewing, cognitive-behavioral therapy (CBT), and a family or caregiverintervention for dual-diagnosis patients with schizophrenia. The interventionwas associated with improvements in general functioning, psychotic symptoms,and SUD outcomes (Barrowclough et al., 2001). Thus, this field continues toevolve and develop creative new treatments that are being tested with increasingmethodological rigor.Other Psychiatric PopulationsIn non-SPMI populations, integrated treatment models have also been developedfor other patient subpopulations with psychiatric disorders and SUDs suchas bipolar disorder (Weiss et al., 2000), personality disorders (Ball, 1998;Linehan et al., 2002), and anxiety disorders such as PTSD (Brady, Dansky,Back, Foa, & Carroll, 2001; Najavits, Weiss, Shaw, & Muenz, 1998), obsessive–compulsive disorder (Fals-Stewart & Schafer, 1992), and social phobia (Randall,Thomas, & Thevos, 2001). With the exception of social phobia, for whichintegrated CBT for social phobia and alcohol use disorders has yielded worseanxiety and drinking outcomes compared to group CBT geared toward alcoholrelapse prevention alone (Randall et al., 2001), preliminary evidence suggeststhat these new treatments are generating some positive results.