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  • Print publication year: 2008
  • Online publication date: May 2010

24 - Treatment of co-occurring psychiatric and substance use disorders

from Part III - Specific treatments
    • By Douglas M. Ziedonis, University of Massachusetts Memorial Medical Center Worcester, MA USA, Ed. Day, Department of Psychiatry Queen Elizabeth Psychiatric Hospital Edgbaston Birmingham UK, Erin L. O'Hea, Department of Psychology La Salle University Philadelphia, PA USA, Jonathan Krejci, Department of Psychiatry Robert Wood Johnson Medical School VA Health Care System Lyons, NJ USA, Jeffrey A. Berman, Department of Psychiatry Robert Wood Johnson Medical School VA Health Care System Lyons New Jersey, NJ USA, David Smelson, Department of Psychiatry Robert Wood Johnson Medical School VA Health Care System Lyons, NJ USA
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511544392.026
  • pp 442-458

Summary

Editor's note

The co-morbidity of a concurrent substance use disorder and a non-substance major psychiatric disorder is quite common. Yet there is very little data available to inform the clinician as to what treatment(s) might be best for this particular group of patients with this particular set of substance abuse plus non-substance psychiatric co-morbidity. In general, the limited research available, consensus recommendations and clinical experiences all suggest that integrated treatment, i.e. treatment by the same group of providers that addresses both the substance misuse and the other major mental illness is most effective. However, there are exceptions to this rule and providers must be flexible and offer a combination of services regarding what works best in treating the mental disorder plus what works best in the treatment of the specific substance abuse disorder. While on the surface this appears to be logical and pragmatic, this kind of reasoning does not always work. For example, there is some evidence that lithium is less effective in people with bipolar disorder complicated by substance abuse than it is in bipolar disorder alone. Furthermore, some pharmacological agents used to treat some psychiatric disorders have an increased liability for abuse and dependency, suggesting greater caution in using these interventions when substance abuse is a comorbid issue. The most efficacious treatment approach is probably integrated multi-modal treatment which involves the same group of caregivers providing treatment to both the mental illness and the substance misuse disorder.

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