People with psychotic disorders as well as substance abuse disorders may gain some relief from their symptoms with cognitive-behavioral therapy (CBT), investigators report.
Dr Amanda Baker (University of Newcastle, New South Wales, Australia) and co-workers investigated the benefit of this treatment in 130 patients suffering from a psychotic disorder (severe depression, bipolar mania, schizophrenia, schizoaffective disorder, or other psychosis). All of the participants also reported extreme alcohol, cannabis, and/or amphetamine use in the preceding month.
The participants either received 10 sessions of motivational interviewing plus CBT or standard care from their clinician.
In the CBT program, the patients were set goals in each session and were taught techniques for managing their substance use disorder more effectively and how to identify triggers and avoid situations that could lead to substance use.
Standard care, on the other hand, involved participants being informed that they were using substances at above recommended levels and being given a self-help booklet. They were also encouraged to maintain or increase their contact with local health services.
In all, two-thirds of the patients completed all 10 CBT sessions. Assessment of symptoms before treatment, and again after 15 weeks, 6 months, and 12 months showed significant improvements in depression and tendency to use less cannabis in patients receiving CBT, as well as a positive effect on general functioning.
"Clearly, this challenging client group is able to engage in CBT and appears to derive benefit from it," say Dr Baker and team.
The intervention failed to impact substance use over the longer-term, however, apart from a reduction in amphetamine use, and both groups of patients experienced significant reductions in alcohol misuse.
This suggest that even minimal interventions as provided with standard care can result in significant changes, the investigators note.
They conclude: "For some people, giving brief advice within the context of ongoing assessment and monitoring may be sufficient to stimulate the initiation of changes in life circumstances.
"For others, specific therapy programs may be required."