Psychose und Sucht bei Jugendlichen und Jungerwachsenen
Teil 2: Verlauf und Behandlung

Zusammenfassung

Trotz hoher Prävalenz der Doppeldiagnose (DD) Psychose und Sucht bei ersterkrankten Jugendlichen und Jungerwachsenen und hoher klinischer Relevanz, bedingt durch den ungünstigen Krankheitsverlauf bei persistierendem Drogenkonsum, existieren nur wenige randomisierte kontrollierte Therapiestudien. Nach therapeutischen Empfehlungen sollte bei dieser Gruppe die psychiatrische Therapie und Suchttherapie integriert werden. Dieser Beitrag skizziert integrierte Versorgungsmodelle und störungsspezifische Kurzzeittherapien aus klinischer und evidenzbasierter Perspektive mit Fokus auf die für DD-Patienten adaptierte Motivationsbehandlung, deren Effektivität bei Suchtstörungen alleine belegt ist. Ziel dieses Beitrags ist es, psychosoziale Behandlungen aufzuzeigen, die den Substanzkonsum bei Jugendlichen und Jungerwachsenen mit Psychose effizient reduzieren könnten. Fünf randomisiert kontrollierte Studien werden besprochen. Diese Überblicksarbeit findet keine Überlegenheit einer speziellen psychosozialen Intervention. Entweder konnten gefundene Effekte nicht repliziert werden oder es konnte kein klarer Vorteil gegenüber Vergleichsbedingungen für substanzspezifische oder andere psychiatrische Zielkriterien bestätigt werden.

Abstract

Despite the high prevalence of comorbid substance use disorders (SUD) in young schizophrenic patients and the association of persisting SUD and poor outcome, there are only few randomized controlled psychological treatment studies in this special dual diagnosis group available. According to therapeutic recommendations, efficient treatment models need to integrate traditional psychiatric therapy and therapy of addiction offered in one setting. Short-term interventions have adapted Motivational interviewing (MI) for dual diagnosis, which has been shown to be effective among other substance abuse disorders. However a recent Cochrane review showed that insufficient evidence exists to show that any psychosocial treatment method for dual diagnosis is superior to others. The aim of this review was to assess the current evidence for the efficacy of psychosocial interventions for reducing substance in young patients with psychosis. Five randomized-controlled studies were identified. This review did not find any specific psychosocial intervention that had been replicated and consistently showed clear advantages over comparison condition for substance-related and other psychiatric outcomes.

Schlüsselwörter

Doppeldiagnose - Krankheitsverlauf - integrierte Versorgung - störungsspezifische Psychotherapien - Evidenzbasierung

Key words

dual diagnosis - psychosis - substance use disorder - clinical course - evidence-based psychosocial treatments

Literatur

• 1 Lambert M, Conus P, Lubman D I. et al . The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis.  Acta Psychiatrica Scandinavica. 2005;  112 141-148
• 2 Harrison I, Joyce E M, Mutsatsa S H. et al . Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study.  Psychological Medicine. 2008;  38 79-88
• 3 Bartels S J, Drake R, Wallach W A. Long-term course of substance use disorders among patients with severe mental illness.  Psychiatric Services. 1995;  46 248-251
• 4 Drake R E, McHugo G J, Xie H. et al . Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders.  Schizophrenia Bulletin. 2006;  32 464-473
• 5 Xie H, McHugo G J, Helmstetter B S. et al . Three-year recovery outcomes for long-term patients with co-occurring schizophrenic and substance use disorders.  Schizophrenia Research. 2005;  75 337-348
• 6 Drake R E, Wallach M A, McGovern M P. Future directions in preventing relapse to substance abuse among clients with severe mental illnesses.  Psychiatric Services. 2005;  56 1297-1302
• 7 Hides L, Dawe S, Kavanagh D J. et al . Psychotic symptom and cannabis relapse in recent-onset psychosis.  British Journal of Psychiatry. 2006;  189 137-143
• 8 Wade D, Harrigan S, Edwards J. et al . Course of substance misuse and daily tobacco use in first-episode psychosis.  Schizophrenia Research. 2006;  81 145-150
• 9 Addington J, Addington D. Patterns, predictors and impact of substance use in early psychosis: a longitudinal study.  Acta Psychiatrica Scandinavica. 2007;  115 304-309
• 10 Caspari D. Cannabis and schizophrenia: results of a follow-up study.  European Archives of Psychiatry and Clinical Neuroscience. 1999;  249 45-49
• 11 Farrelly S, Harris M G, Henry L G. et al . Prevalence and correlates of comorbidity 8 years after a first psychotic episode.  Acta Psychiatrica Scandinavica. 2007;  116 62-70
• 12 Westermeyer J. Comorbid schizophrenia and substance abuse: a review of epidemiology and course.  American Journal on Addictions. 2006;  15 345 s-355
• 13 Westermeyer J, Schneekloth T. Course of substance abuse in patients with and without schizophrenia.  American Journal on Addictions. 1999;  8 54-63
• 14 Dixon L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes.  Schizophrenia Research. 1999;  35 93-100
• 15 Linszen D H, Dingemans P M, Lenior M E. Cannabis use and the course of recent onset schizophrenic disorders.  Archives of General Psychiatry. 1994;  51 273-279
• 16 Linszen D H, Dingemans P M, Nugter M A. Patient attributes and expressed emotion as risk factors for psychotic relapse.  Schizophrenia Bulletin. 1997;  23 119-130
• 17 Haywood T W, Kravitz H M, Grossman L S. et al . Predicting the „revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders.  American Journal of Psychiatry. 1995;  152 856-861
• 18 Wade D, Harrigan S, Whelan G. et al . The impact of substance use disorders on clinical outcome in first-episode psychosis.  Schizophrenia Research. 2004;  67 172
• 19 Margolese H C, Negrete J C, Tempier R. et al . A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: Changes in psychiatric symptoms and substance use.  Schizophrenia Research. 2006;  83 65-75
• 20 Talamo A, Centorrino F, Tondo L. et al . Comorbid substance-use in schizophrenia: relation to positive and negative symptoms.  Schizophrenia Research. 2006;  86 251-255
• 21 Wade D, Harrigan S, McGorry P D. et al . Impact of severity of substance use disorder on symptomatic and functional outcome in young individuals with first-episode psychosis.  Journal of Clinical Psychiatry. 2007;  68 767-774
• 22 Margolese H C, Malchy L, Negrete J C. et al . Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences.  Schizophrenia Research. 2004;  67 157-166
• 23 Janssen B, Gaebel W, Haerter M. et al . Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders.  Psychopharmacology. 2006;  187 229-236
• 24 Hunt G E, Bergen J, Bashir M. Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse.  Schizophrenia Research. 2002;  54 253-264
• 25 Soyka M. Substance misuse, psychiatric disorder and violent and disturbed behaviour.  British Journal of Psychiatry. 2000;  176 345-350
• 26 Regier D A, Farmer M E, Rae D S. et al . Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study.  Journal of the American Medical Association. 1990;  264 2511-2518
• 27 Goodman L A, Rosenberg S D, Mueser K T. et al . Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions.  Schizophrenia Bulletin. 1997;  23 685-696
• 28 Cohen L J, Test M A, Brown R J. Suicide and schizophrenia: data from a prospective community treatment study.  American Journal of Psychiatry. 1990;  147 602-607
• 29 Gut-Fayand A, Dervaux A, Olie J P. et al . Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity.  Psychiatry Research. 2001;  102 65-72
• 30 Buhler B, Hambrecht M, Loffler W. et al . Precipitation and determination of the onset and course of schizophrenia by substance abuse – a retrospective and prospective study of 232 population-based first illness episodes.  Schizophrenia Research. 2002;  54 243-251
• 31 Mueser K T, Yarnold P R, Rosenberg S D. Substance use disorder in hospitalized severely mentally ill psychiatric patients: prevalence, correlates, and subgroups.  Schizophrenia Bulletin. 2000;  26 179-192
• 32 Brunette M F, Mueser K T, Drake R E. A review of research on residential programs for people with severe mental illness and co-occuring substance use disorders.  Drug and Alcohol Review. 2004;  23 471-481
• 33 Bartels S J, Teague G B, Drake R E. Substance abuse in schizophrenia: service utilization and costs.  Journal of Nervous and Mental Disease. 1993;  181 227-232
• 34 Dickey B, Azeni H. Persons with dual diagnosis of substance abuse and major mental illness: their excess costs of psychiatric care.  American Journal of Public Health. 1996;  86 973-977
• 35 Dixon L, Haas G H, Weiden P J. et al . Drug abuse in schizophrenic patients: clinical correlates and reasons for use.  American Journal of Psychiatry. 1991;  148 224-230
• 36 Arndt S, Tyrrell G, Flaum M. et al . Comorbidity of substance abuse and schizophrenia: the role of premorbid adjustment.  Psychological Medicine. 1992;  22 379-388
• 37 Sevy S, Robinson D G, Holloway S. Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder.  Acta Psychiatrica Scandinavica. 2001;  104 367-374
• 38 Larsen T K, Melle I, Auestad B. et al . Substance abuse in first-episode non-affective psychosis.  Schizophrenia Research. 2006;  88 55-62
• 39 Penk W E, Flannery R B, Irvin E. et al . Characteristics of substance-abusing persons with schizophrenia: the paradox of the dually diagnosed.  Journal of Addictive Diseases. 2000;  19 23-30
• 40 Tsuang M T, Simpson J C, Zronfonl Z. Subtypes of drug abuse with psychosis. Demographic characteristics, clinical features, and family history.  Archives of General Psychiatry. 1982;  38 141-147
• 41 Potvin S, Sephery A A, Stip E. A meta-analysis of negative symptoms in dual diagnosis schizophrenia.  Psychological Medicine. 2006;  36 431-440
• 42 Potvin S, Joyal C C, Pelletier J. et al . Contradictory cognitive capacities among substance-abusing patients with schizophrenia.  Schizophrenia Research. 2008;  100 242-251
• 43 Schnell T, Koethe D, Daumann J. et al . The role of cannabis in cognitive functioning of patients with schizophrenia.  Psychopharmacology. 2009;  205 45-52
• 44 Joyal C C, Hallé P, Lapierre D. et al . Drug abuse and/ or dependence and better neuropsychological performance in patients with schizophrenia.  Schizophrenia Research. 2003;  63 297-299
• 45 Phillips P, Johnson S. How does drug and alcohol misuse develop among people with psychotic illness? A literature review.  Social Psychiatry and Psychiatric Epidemiology. 2001;  36 269-276
• 46 Gouzoulis-Mayfrank E. Komorbidität Psychose und Sucht: Grundlagen und Praxis:. Steinkopff Verlag 2007
• 47 Drake R E, Mueser K T, Brunette M F. et al . A review of treatments for people with severe mental illnesses and co-occurring substance use disorders.  Psychiatric Rehabilitation Journal. 2004;  27 360-374
• 48 Drake R E, O’Neal E L, Wallach M. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders.  Journal of Substance Abuse Treatment. 2008;  34 123-138
• 49 Ziedonis D M, Smelson D, Rosenthal R N. et al . Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations.  Journal of Psychiatric Practice. 2005;  11 315-339
• 50 Mueser K T, Drake D, Sigmon S. et al . Psychosocial interventions for adults with severe mental illnesses and co-occurring substance use disorders: a review of specific interventions.  Journal of Dual Diagnosis. 2005;  1 57-82
• 51 Ridgely M S, Goldman H H, Willenbring M. Barriers to the care of persons with dual diagnoses: organisational and financing issues.  Schizophrenia Bulletin. 1990;  16 123-132
• 52 Osher F C, Drake R E. Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders.  American Journal of Orthopsychiatry. 1996;  66 4-11
• 53 Horn D H, Bux D A. A pilot test of motivational interviewing groups for dually diagnosed inpatients.  Journal of Substance Abuse Treatment. 2001;  20 191-195
• 54 Ridgely M S. Creating integrated programs for severely mentally ill persons with substance disorders.  New Directions for Mental Health Services. 1991;  50 29-41
• 55 Epstein van J, Barker P, Vorburger M. et al .Serious mental illness and its co-occurrence with substance use. Rockville; Substance abuse and mental health services administration, office of applied studies 2004
• 56 Brunette M F, Mueser K T. Psychosocial interventions for the long-term management of patients with severe mental illness and co-occuring substance use disorders.  Journal of Clinical Psychiatry. 2006;  67 10-17
• 57 Cleary M, Hunt G E, Matheson S. et al . Psychosocial treatment programmes for people with both severe mental illness and substance misuse.  Cochrane Database of Systematic Reviews. 2008;  CD001088
• 58 Osher F C, Kofoed L L. Treatment of patients with psychiatric and psychoactive substance use disorders.  Hospital and Community Psychiatry. 1989;  40 1025-1030
• 59 McHugo G J, Drake R E, Burton H L. et al . A scale for assessing the stage of substance abuse treatment in persons with severe mental illness.  Journal of Nervous and Mental Disease. 1995;  183 762-767
• 60 Prochaska J O, DiClemente C C, Norcross J. In search of how people change.  American Psychologist. 1992;  47 1101-1114
• 61 DiClemente C C, Nidecker M, Bellack A S. Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders.  Journal of Substance Abuse Treatment. 2008;  34 25-35
• 62 Dumaine M L. Meta-analysis of interventions with co-occurring disorders of severe mental illness and substance abuse: implications for social work practice.  Research on Social Work Practice. 2003;  13 142-165
• 63 Donald M, Dower J, Kavanagh D J. Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials.  Social Science and Medicine. 2005;  60 1371-1383
• 64 Carey K B, Purnine D M, Maisto S A. et al . Treating substance abuse in the context of severe and persistent mental illness: Clinicians’ perspectives.  Journal of Substance Abuse Treatment. 2000;  19 189-198
• 65 Laker C J. How reliable is the current evidence looking at the efficacy of harm reduction and motivational interviewing interventions in the treatment of patients with a dual diagnosis?.  Journal of Psychiatric and Mental Health Nursing. 2007;  14 720-726
• 66 Tsuang J, Fong T W, Lesser I L. Psychosocial treatment of patients with schizophrenia and substance abuse disorders.  Addictive Disorders & their Treatment. 2006;  5 53-66
• 67 Drake R E, Mercer-McFadden C, Mueser K T. et al . Review of integrated mental health and substance abuse treatment for patients with dual disorders.  Schizophrenia Bulletin. 1998;  24 589-608
• 68 Gouzoulis-Mayfrank E. Doppeldiagnose Psychose und Sucht – Grundlagen und Therapie.  Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. 2008;  36 245-253
• 69 Tiet Q Q, Mausbach B. Treatments for patients with dual diagnosis: a review.  Alcoholism: Clinical and Experimental Research. 2007;  31 513-536
• 70 Cleary M, Hunt G E, Matheson S. et al . Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review.  Journal of Advanced Nursing. 2009;  65 238-258
• 71 Ley A, Jeffery D P, McLaren S. et al . Psychosocial treatment programs for people with both severe mental illness and substance misuse.  The Cochrane Library. 2000;  3 1-37
• 72 McHugo G J, Drake R E, Teague G B. et al . Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study.  Psychiatric Services. 1999;  50 818-824
• 73 Essock S M, Mueser K T, Drake R E. et al . Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders.  Psychiatric Services. 2006;  57 185-196
• 74 Tarrier N. Cognitive behaviour therapy for schizophrenia – a review of development, evidence and implementation.  Psychotherapy and Psychosomatics. 2005;  74 136-144
• 75 Jones C, Cormac I, Silveira da Mota Neto J I. et al . Cognitive behaviour therapy for schizophrenia.  Cochrane Database of Systematic Reviews. 2004;  CD000524
• 76 Pekkala E, Merinder L. Psychoeducation for schizophrenia.  Cochrane Database of Systematic Reviews. 2006; 
• 77 Copeland J, Swift W, Roffman R. et al . A randomized controlled trial of brief cognitive – behavioral interventions for cannabis use disorder.  Journal of Substance Abuse Treatment. 2001;  21 55-64
• 78 Bellack A S, DiClemente C C. Treating substance abuse among patients with schizophrenia.  Psychiatric Services. 1999;  50 75-80
• 79 Bellack A S, Bennett M E, Gearon J S. et al . A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness.  Archives of General Psychiatry. 2006;  63 426-432
• 80 D’Amelio R, Behrendt B, Wobrock T. Psychoedukation Schizophrenie und Sucht. Manual zur Leitung von Patienten- und Angehörigengruppen. München; Elsevier/Urban & Fischer 2007
• 81 Burlon M, Huber C. Suchtstörungen im Kindes- und Jugendalter: Das Handbuch: Grundlagen und Praxis. Thomasius R, Schulte-Markwort M, Küstner U, et al Stuttgart; Schattauer 2009: 82-87
• 82 Ziedonis D M, Trudeau K. Motivation to quit using substances among individual with schizophrenia: implications for a motivation-based treatment model.  Schizophrenia Bulletin. 1997;  23 229-238
• 83 Miller W R, Rollnick S. Motivational interviewing: preparing people for change. New York; Guilford Press 2002 2nd ed
• 84 Burke B, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.  Journal of Consulting and Clinical Psychology. 2003;  71 843-861
• 85 Hettema J, Steele J, Miller W R. Motivational interviewing.  Annual Review of Clinical Psychology. 2005;  1 91-111
• 86 Chanut F, Brown T G, Dongier M. Motivational interviewing and clinical psychiatry.  Canadian Journal of Psychiatry. 2005;  50 715-721
• 87 Rogers C R. Client-centered therapy: its current practice, implications, and theory. Boston (MA); Houghton Mifflin 1951
• 88 Festinger L A. A theory of cognitive dissonance. Stanford; Standford University Press 1957
• 89 Carey K B, Leontieva L, Dimmock J. et al . Adapting motivational interventions for comorbid schizophrenia and alcohol use disorders.  Clinical Psychology: Science and Practice. 2007;  14 39-57
• 90 Carey K B, Purnine D M, Maisto S A. et al . Enhancing readiness-to-change substance abuse in persons with schizophrenia. A four-session motivation-based intervention.  Behaviour Modification. 2001;  25 331-384
• 91 Martino S, Carroll K, Kostas D. et al . Dual diagnosis motivational interviewing: A modification of motivational interviewing for substance-abusing patients with psychotic disorders.  Journal of Substance Abuse Treatment. 2002;  23 297-308
• 92 Martino S. Contemplating the Use of Motivational Interviewing With Patients Who Have Schizophrenia and Substance Use Disorders.  Clinical Psychology: Science and Practice. 2007;  14 58-63
• 93 Bechdolf A, Pohlmann B, Reck C. et al . Motivationsbehandlung bei Patienten mit der Doppeldiagnose Psychose und Sucht: Eine Übersicht.  Fortschr Neurol Psychiatr. 2005;  73 728-735
• 94 McHugo G J, Drake R E, Brunette M F. et al . Methodological issues in research on interventions for co-occurring disorders.  Schizophrenia Bulletin. 2006;  32 655-665
• 95 Hulse G K, Tait R J. Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders.  Drug and Alcohol Review. 2002;  21 105-112
• 96 Martino S, Carroll K M, Nich C. et al . A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders.  Addiction. 2006;  101 1479-1492
• 97 Martino S, Carroll K M, O’Malley S S. et al . Motivational interviewing with psychiatrically ill substance abusing patients.  American Journal on Addictions. 2000;  9 88-91
• 98 Santa Ana E J, Wulfert E, Nietert P J. Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence.  Journal of Consulting and Clinical Psychology. 2007;  75 816-822
• 99 James W, Koh G, Spencer C. et al .Managing mental health & drug use. Perth, Western Australia; Uniprint 2002
• 100 Gouzoulis-Mayfrank E. Komorbidität von Sucht und anderen psychischen Störungen – Grundlagen und evidenzbasierte Therapie.  Fortschr Neurol Psychiatr. 2008;  76 263-271
• 101 Warren J I, Stein J A, Grella C E. Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders.  Drug and Alcohol Dependence. 2007;  89 267-274
• 102 Moher D, Pham B, Jones A. et al . Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.  Lancet. 1998;  352 609-613
• 103 Swanson A J, Pantalon M V, Cohen K R. Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients.  Journal of Nervous and Mental Disease. 1999;  187 630-635
• 104 Baker A, Lewin T J, Reichler H. et al . Evaluation of a motivational interview for substance use within psychiatric in-patient services.  Addiction. 2002;  97 1329-1337
• 105 Schmitz J M, Averill P, Sayre S. et al . Cognitive-behavioral treatment of bipolar disorder and substance abuse: a preliminary randomized study.  Addictive Disorders & their Treatment. 2002;  1 17-24
• 106 Weiss R D, Griffin M L, Kolodziej M E. et al . A randomized trial of integrated group therapy versus group drug counseling for bipolar disorder and substance dependence.  American Journal of Psychiatry. 2007;  164 100-107
• 107 Graeber D A, Moyers T B, Griffith G. et al . A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders.  Community Mental Health Journal. 2003;  39 189-202
• 108 Bradley A C, Baker A, Lewin T J. Group intervention for coexisting psychosis and substance use disorders in rural Australia: outcomes over 3 years.  Australian and New Zealand Journal of Psychiatry. 2007;  41 501-508
• 109 James W, Preston N J, Koh G. et al . A group intervention which assists patients with dual diagnosis reduce their drug use: a randomised controlled trial.  Psychological Medicine. 2004;  34 983-990
• 110 Kemp R, Harris A, Vurel E. et al . Stop using stuff: trial of a drug and alcohol intervention for young people with comorbid mental illness and drug and alcohol problems.  Australasian Psychiatry. 2007;  15 490-493
• 111 Naeem F, Kingdon D, Turkington D. Cognitive behaviour therapy for schizophrenia in patients with mild to moderate substance misuse problems.  Cognitive Behaviour Therapy. 2005;  34 207-215
• 112 Hjorthøj C, Fohlmann A, Larsen A. et al . Design paper: the CapOpus trial: A randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis.  Trials. 2008;  9 42
• 113 Jadad A R, Moore R A, Carrol D. et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary?.  Controlled Clinical Trials. 1996;  17 1-12
• 114 Boutron I, Moher D, Altman D G. et al . Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration.  Annals of internal medicine. 2008;  148 295-309
• 115 Barrowclough C, Haddock G, Tarrier N. et al . Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders.  American Journal of Psychiatry. 2001;  158 1706-1713
• 116 Baker A, Bucci S, Lewin T J. et al . Cognitive–behavioural therapy for substance use disorders in people with psychotic disorders: Randomised controlled trial.  British Journal of Psychiatry. 2006;  188 439-448
• 117 Baker A, Lee N K, Claire M. et al . Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction.  Addiction. 2005;  100 367-378
• 118 Bland J M, Kerry S M. Trials randomised in clusters.  British Medical Journal. 1997;  315 600
• 119 Edwards J, Elkins K, Hinton M. et al . Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis.  Acta Psychiatrica Scandinavica. 2006;  114 109-117
• 120 Kavanagh D J, Young R, White A. et al . A brief motivational intervention for substance misuse in recent-onset psychosis.  Drug and Alcohol Review. 2004;  23 151-155
• 121 Haddock G, Barrowclough C, Tarrier N. et al . Cognitive–behavioural therapy and motivational intervention for schizophrenia and substance misuse.  British Journal of Psychiatry. 2003;  183 418-426
• 122 Altman D G, Schulz K F, Moher D. et al . The revised CONSORT statement for reporting randomized trials: explanation and elaboration.  Annals of Internal Medicine. 2001;  134 663-694
• 123 Moher D, Schulz K F, Altman D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials.  Journal of the American Medical Association. 2001;  285 1987-1991
• 124 Campbell M K, Elbourne D R, Altman D G. CONSORT statement: extension to cluster randomised trials.  British Medical Journal. 2004;  328 702-708
• 125 Cuffel B J. Prevalence estimates of substance abuse in schizophrenia and their correlates.  Journal of Nervous and Mental Disease. 1992;  180 589-592
• 126 Xie H, McHugo G M, Fox M B. Substance abuse relapse in a ten-year prospective follow-up of clients with co-occurring severe mental and substance use disorders.  Psychiatric Services. 2005;  56 1282-1287
• 127 Rollins A L, O’Neill S J, Davis K E. Substance abuse relapse and factors associated with relapse in an inner-city sample of patients with dual diagnoses.  Psychiatric Services. 2005;  56 1274-1281
• 128 Bradizza C M, Stasiewicz P R. Qualitative analysis of high-risk drug and alcohol use situations among severely mentally ill substance abusers.  Addictive Behaviors. 2003;  28 157-169
• 129 Salyers M, Becker D R, Drake R E. A ten-year follow-up of supported employment.  Psychiatric Services. 2004;  55 302-308
• 130 Bradizza C M, Stasiewicz P R, Carey K B. High-risk alcohol and drug use situations among seriously mentally ill patients: a preliminary investigation.  Addictive Behaviors. 1998;  23 555-560
• 131 Alverson H, Alverson M, Drake R E. Social patterns of substance use among people with dual diagnoses.  Mental Health Services Research. 2001;  3 3-14
• 132 Bartels S J, Drake R E. Residential treatment for dual diagnosis.  Journal of Nervous and Mental Disease. 1996;  184 379-381
• 133 Sorbara F, Liraud F, Assens F. et al . Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects.  European Psychiatry. 2003;  18 133-136
• 134 Coldham E L, Addingtin J, Addington D. Medication adherence of individuals with a first episode of psychosis.  Acta Psychiatrica Scandinavica. 2002;  106 286-290
• 135 Kamali M, Kelly L, Gervin M. et al . Psychopharmacology: insight and comorbid substance misuse and medication compliance among patients with schizophrenia.  Psychiatric Services. 2001;  52 161-166
• 136 Soyka M, Albus M, Kathmann N. Prevalence of alcohol and drug abuse in schizophrenic inpatients.  European Archives of Psychiatry and Clinical Neuroscience. 1993;  242 362-372
• 137 Verdoux H, Liraud P, Gonzales B. et al . Suicidality and substance misuse in first-admitted subjects with psychotic disorder.  Acta Psychiatrica Scandinavica. 1999;  100 389-395
• 138 Lukoff D, Nuechterlein K H, Ventura J. Manual for expanded Brief Psychiatric Rating Scale (BPRS).  Schizophrenia Bulletin. 1986;  12 594-602
• 139 Beck A T, Steer R A, Brown G K. Beck Depression Inventory: Second Edition Manual. Orlando, FL; Harcourt Brace and Company 1996
• 140 Kay S R, Fiszbein A, Opler L A. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.  Schizophrenia Bulletin. 1987;  13 261-276
• 141 Andreasen N C. Negative symptoms in schizophrenia.  Archives of General Psychiatry. 1982;  39 784-788
• 142 Birchwood M, Smith J, Cochrane R. et al . The Social Functioning Scale: the development and validation of a scale of social adjustment for use in family intervention programmes with schizophrenic patients.  British Journal of Psychiatry. 1990;  157 853-859
• 143 Goldman H H, Skodal A E, Lave T R. Revising axis V for DSM-IV: a review of measures of social functioning.  American Journal of Psychiatry. 1992;  149 1148-1156
• 144 McLellan A T, Kushner H, Metzger D. et al . The fifth edition of the Addiction Severity Index.  Journal of Substance Abuse Treatment. 1992;  9 199-213
• 145 Darke S, Hall W, Wodak A. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index.  British Journal of Addiction. 1992;  87 733-742
• 146 Mueser K T, Drake R E, Clark R E. et al .Evaluating substance abuse in persons with severe mental illness. Cambridge; Human Services Research Institute 1995
• 147 Raistrick D, Bradshaw J, Tober G. et al . Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package.  Addiction. 1994;  89 563-572
• 148 Wing J K, Babor T, Brugha T. SCAN. Schedules for clinical assessment in neuropsychiatry.  Archives of General Psychiatry. 1990;  47 (6) 589-593
• 149 Saunders J B, Aasland O G, Babor T F. et al . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption-II.  Addiction. 1993;  88 791-804
• 150 Gossop M, Darke S, Griffiths P. The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.  Addiction. 1995;  90 607-614
• 151 Rollnick S, Heather N, Gold R. et al . Development of a short „readiness to change” questionnaire for use in brief, opportunistic interventions among excessive drinkers.  British Journal of Addiction. 1992;  87 743-754
• 152 McConnaughy E A, Prochaska J O, Velicer F. Stages of change in psychotherapy: measurement and sample profiles.  Psychotherapy. 1983;  20 368-375