Group intervention for coexisting psychosis and substance use disorders in rural Australia: outcomes over 3 years

Abstract

Objective: Outpatient group interventions have been shown to be efficacious in reducing substance use among people with psychosis. This is the first Australian study to report on the effectiveness of such interventions provided in a rural area by mental health and drug and alcohol clinicians, with follow up over 3 years. The primary aim was to investigate whether an open-ended weekly outpatient group intervention, consisting of motivational interviewing (MI) and cognitive behaviour therapy (CBT), was effective in reducing substance use and improving symptomatology and general functioning among people with psychosis.

Method: This was a service evaluation project, with clinician-administered ratings made for four retrospective 3 monthly baseline observations and up to 12 3 monthly post-recruitment observations.

Results: Thirty-nine participants entered the group intervention, with an average attendance of 28.51 sessions (SD=24.61). Compared to a baseline period of 1 year, the group intervention was associated with significant improvements in substance use, symptomatology, treatment non-compliance, overall functioning and unscheduled service use. A median split according to treatment group attendance indicated that there was no difference in improvement profiles on a factor reflecting overall severity among those who attended fewer (mean=10.63) versus more sessions (mean=45.50), but there was a sharper reduction in the use of acute mental health services among those who attended more sessions.

Conclusions: Significant change in functioning (including substance use and symptomatology) can occur within the context of a regular but relatively short outpatient group intervention, delivered in addition to usual treatment. However, extended group attendance over a 1 year period may be further associated with prevention of relapse and less unscheduled service use.