Trans-Sector Integrated Treatment in Psychosis and Addiction

Abstract

Background: Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat. Long-term integrated treatment programs might improve such patients' outcomes, at least to a moderate extent, but they have not yet been adequately studied or implemented in Germany to date.

Methods: 100 dual diagnosis patients participated in a single-center, randomized, controlled trial under standard hospital treatment conditions. They were randomly allotted to two groups. Patients in the intervention group were admitted to a specialized open hospital ward, where they were given integrated treatment, including disorder-specific group therapy. Their treatment was continued with further disorder-specific group therapy in the outpatient setting. Patients in the control group were admitted to an open general psychiatric ward and received treatment as usual, but no disorder-specific treatment either during their hospitalization or in the subsequent outpatient phase. Follow-up examinations were performed three, six, and twelve months after inclusion. The primary outcome was defined as the changes in substance use and abstinence motivation. The secondary outcome consisted of the patients' satisfaction with treatment and with life in general, retention rate, psychopathology, rehospitalizations, and global level of functioning.

Results: The patients in the intervention group developed higher abstinence motivation than those in the control group (p = 0.009) and transiently reduced their substance use to a greater extent (p = 0.039 at three months). They were also more satisfied with their treatment (group effect: p = 0.011). Their global level of functioning and their retention rate were also higher, but these differences did not reach statistical significance.

Conclusion: Low-threshold, motivational, integrated treatment programs with psycho-educative and behavioral therapeutic elements may be helpful in the treatment of dual diagnosis patients and should be more extensively implemented as part of standard hospital treatment. Larger-scale, methodologically more complex studies will be needed to identify subgroups of patients that respond to such treatments in different ways.

Figure 1

Recruitment

Figure 2a

Changes to the intensity of consumption of the main substance in the follow-up period from t₀ to t₁ Number of patients by class of change in consumption from baseline IntT, integrated treatment program; TAU, treatment as usual

Figure 2b

Motivation for abstinence Scale readings from SOCRATES questionnaire (means, 95% confidence intervals) IntT, integrated treatment program; TAU, treatment as usual; SOCRATES, Stages of Change Readiness and Treatment Eagerness Scale; t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months

Figure 3a

Retention rate Numbers of patients who remained in the program over the course of the study. IntT, integrated treatment program; TAU, treatment as usual; t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months

Figure 3b

Satisfaction with treatment Scale reading from the ZUF-8 questionnaire on patient satisfaction (mean, 95% confidence interval) IntT, integrated treatment program; TAU, treatment as usual; t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months

Figure 3c

Global level of functioning Scale readings from Global Assessment of Functioning (GAF) Scale (mean, 95% confidence interval) IntT, integrated treatment program; TAU, treatment as usual; t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months

eFigure 2

Motivation for abstinence Scale values of the SOCRATES questionnaire (means, 95% confidence intervals) IntT, integrated treatment program; TAU, treatment as usual; SOCRATES, Stages of Change Readiness and Treatment Eagerness Scale; t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months

eFigure 2

Changes in the intensity of consumption of the main substance in the follow-up periods t₀ to t₂ and t₀ to t₃ Number of patients by class of change in consumption, from baseline; IntT, integrated treatment program; TAU, treatment as usual t₀, baseline; t₁, + 3 months; t₂, + 6 months; t₃, + 12 months