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Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review |
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| Authors: | Michelle Cleary,Glenn E. Hunt,Sandra Matheson,& Garry Walter |
| Affiliation: | Michelle Cleary PhD RN Clinical Associate Professor Mental Health Faculty of Nursing and Midwifery, University of Sydney, and Clinical Nurse Consultant Research Unit, Sydney South West Area Mental Health Service, New South Wales, Australia; Glenn E. Hunt PhD Senior Research Fellow Discipline of Psychological Medicine, University of Sydney and Research Unit, Sydney South West Area Mental Health Service, New South Wales, Australia; Sandra Matheson BSc Research Officer Research Unit, Sydney South West Area Mental Health Service, New South Wales, Australia; Garry Walter MBBS BMedSc PhD Professor of Child and Adolescent Psychiatry University of Sydney, and Area Clinical Director Child and Adolescent Mental Health Services, Northern Sydney Central Coast Health, New South Wales, Australia |
| Abstract: | Title. Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: systematic review. Aim. This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background. Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources. Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods. Results from studies using meta‐analysis, randomized and non‐randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results. Fifty‐four studies were included: one systematic review with meta‐analysis, 30 randomized controlled trials and 23 non‐experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long‐term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion. These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups. |
| Keywords: | dual diagnosis nursing psychosocial treatments severe mental illness substance misuse systematic review |