Randomized Controlled Trial of Motivational Interviewing, Cognitive Behavior Therapy, and Family Intervention for Patients With Comorbid Schizophrenia and Substance Use Disorders

TLDR

Comorbidity of substance abuse with schizophrenia increases risk of serious complications and worsens outcomes, yet few rigorous studies evaluate treatment approaches. The study examines whether adding an integrated psychological and psychosocial program to routine psychiatric care benefits patients with schizophrenia and substance use disorders. A randomized, single‑blind controlled trial compared routine care alone to routine care plus motivational interviewing, cognitive‑behavioral therapy, and family/caregiver intervention. The integrated program produced significantly greater improvements in general functioning, reduced positive symptoms and exacerbations, and increased abstinence days over 12 months compared with routine care alone.

Abstract

OBJECTIVE: Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome. Methodologically sound studies investigating treatment approaches for patients with these disorders are rare, although recommendations for integrated and comprehensive treatment programs abound. This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders. METHOD: The authors conducted a randomized, single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family or caregiver intervention. RESULTS: The integrated treatment program resulted in significantly greater improvement in patients’ general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study. Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up. CONCLUSIONS: These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence.