Psychosocial interventions for people with both severe menta | Figure 1

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Psychosocial interventions for people with both severe mental illness and substance misuse

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What is the aim of this review?

The aim of this Cochrane Review is to find out if psychosocial interventions aimed at reducing substance abuse in people with a serious mental illness improve patient outcomes compared to standard care. Researchers in the Cochrane collected and analysed all relevant studies that randomly allocated people with severe mental illness and substance misuse to a psychosocial treatment or standard care to answer this question and found 41 relevant studies.

Key message

From these 41 studies we did not find any high‐quality evidence to support any one psychosocial intervention over standard care. However, the differences in study designs made comparisons between studies problematic.

What was studied in the review?

“Dual” diagnosis is the term used to describe people who have a mental health problem and also have problems with drugs or alcohol. In some areas, over 50% of all those with a serious mental illness (these include schizophrenia, bipolar disorders and major depression) will have problems with drugs or alcohol that have negative and damaging effects on the illness symptoms and the way their medication works. People who have substance misuse problems can be treated via a variety of psychosocial interventions. These include motivational interviewing, or MI, that looks at people’s motivation for change; cognitive behavioural therapy, or CBT, which helps people adapt their behaviour by improving coping strategies; contingency management which rewards patients to abstain from taking substances, psycho‐education for patients and their carers or family, group and individual skills training. Other interventions include provider‐oriented long‐term interventions unifying services to provide integrated treatment so patients do not have to negotiate separate mental health and substance abuse treatment programmes. Integrated care is often linked to assertive community treatment (ACT) for patients with a dual diagnosis. There are a variety of psychosocial interventions that can be added to routine care and these can be provided individually or in various combinations. Currently, we do not know if any psychosocial treatment is better or worse than standard care or if they work better given in combination or individually.

What are the main results of the review?

The review found 41 relevant studies with a total of 4024 people. These studies looked at a variety of different psychosocial interventions (including CBT, MI, skills training, integrated models of care and contingency management) and compared them to standard care (the care a participant in the trial would normally receive). Main results showed there was:

  1. no real difference in terms of numbers lost to treatment (low‐quality evidence);

  2. no real difference in terms of death (low‐quality evidence);

  3. no real difference in alcohol or substance used (low‐quality evidence);

  4. no real difference in global functioning or general life satisfaction (low‐ to moderate‐quality evidence).

In addition, studies had high numbers of people leaving early, differences in outcomes measured, and differing ways in which psychosocial interventions were delivered. More large‐scale, high‐quality and better reported studies are required to address these shortcomings. This will better address whether psychosocial interventions are effective for people with serious mental illness and substance misuse problems.

How up‐to‐date is this review?

The review authors searched for studies that had been published up to October 2018.

Read the full Cochrane Review here

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