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 291standardized assessment such as the Adult Behavior Checklist (Murphy& Barkley, 1996) or the Beck Anxiety Inventory (Beck, Epstein, Brown,& Steer, 1988) can help document improvements (or lack thereof).• Monitor substance use. Patients should be asked about alcohol and druguse, and other sources of information (urine screens, collateral informationfrom family members) should be strongly considered.• Enlist family members in supporting and monitoring the patient. Verify theefficacy and appropriate use of the medication with family members.• Patients should safeguard medications. While the patient may not abusethe medication, family members may.• Monitor prescriptions. Keep careful track of the number of pills you prescribe,and beware of warning signs of abuse, such as premature requestsfor refills or “lost prescriptions.” These usually indicate overuse of themedication.Pharmacotherapy Targeting Substance Dependencein Dually Diagnosed PopulationsAlthough pharmacotherapies aimed specifically at decreasing alcohol or druguse (e.g., naltrexone, disulfiram) can be efficacious in improving SUD outcomesin non-dually-diagnosed populations, the literature on the use of thesemedications in dually diagnosed populations is quite thin. Concerns thatdisulfiram may cause or exacerbate psychosis (Mueser, Noordsy, Fox, & Wolfe,2003) have contributed to a reluctance to prescribe it in patients with SPMI(Kingsbury & Salzman, 1990). While there have been no controlled studies ofdisulfiram in populations with alcohol dependence and SPMI, there have beena few published case reports (Brenner, Karper, & Krystal, 1994) and case series(Kofoed, Kania, Walsh, & Atkinson, 1986; Mueser et al., 2003) describing itstolerability and potential benefit for improving alcohol outcomes and hospitalizationrates for those who remain in treatment. Additionally, there is preliminaryevidence that naltrexone may improve drinking outcomes in patients withalcohol dependence and schizophrenia (Batki et al., 2002) or major depression(Salloum et al., 1998). The benefit or tolerability of naltrexone in patients withbipolar disorder and alcohol disorders is less clear, based on one case report(Sonne & Brady, 2000).INTEGRATION OF PSYCHOTHERAPY ANDPHARMACOTHERAPY FOR DUALLY DIAGNOSED PATIENTSIntegrated psychosocial treatments are increasingly accepted and provided topatients as more and varied evidence accrues regarding their benefits. However,there continue to be few trials that integrate novel psychosocial treatments