Substance Misuse in Psychosis : Approaches to Treatment and Service Delivery

The prevalence of substance abuse in the severely mentally ill ishigher than that in the general population, making this a seriousissue for clinicians. Integrated treatment, although the mostwidely adopted approach, is subject to tremendous variation in itsoperationalisation, especially throughout different parts of theworld.

Substance Misuse in Psychosis presents the latest internationaldevelopments and practical treatment interventions that can be usedwith co-morbid individuals and their families. Different social andcultural contexts are described and contrasted, along withtreatment approaches that have been tailored to address the needsof the severely mentally ill. A final section considers sub-groups,e.g. the young, the homeless, outlining the special issues thatneed to be considered when providing services for these groups.

Hermine L. Graham is a consultant clinical psychologist, Head of the Combined Psychosis and Substance Use (COMPASS) Programme in Northern Birmingham, UK, and an Honorary Research Fellow with the School of Psychology, University of Birmingham. In a managerial and clinical research capacity she is developing and evaluating an integrated treatment and service model for people with severe mental health problems who use alcohol/drugs problematically. She has published articles within this area and provides national and international consultancy/advice on service and policy developments for this client group. Her clinical and research interests include the application of cognitive therapy for people with combined psychosis and substance use. A publication that reflects this is her paper, "The Role of Dysfunctional Beliefs in Individuals Who Experience Psychosis and Use Substances: Implications for Cognitive Therapy and Medication Adherence" (1998), Behavioural and Cognitive Psychotherapy, 26, 193-208.

Alex Copello is a consultant clinical psychologist, Head of the Psychology Addiction Speciality within Northern Birmingham Mental Health Trust, and Lecturer in Clinical Psychology at the School of Psychology, University of Birmingham. He is a practising clinician and the lead professional for the Addiction Research and Development Programme for the Trust. In addition, he is one of the principal investigators on an MRC-funded UK multisite study evaluating alcohol treatment. He has been involved in developing a social network-based treatment that will be evaluated in this study. His research and clinical interests include the impact of addiction upon families; the evaluation of services for alcohol and drug users, both in primary care and specialist settings; and the use of qualitative research methods. He has also been involved in international cross-cultural research assessing the impact of addiction on families in Mexico and Australia. He publishes extensively in a number of scientific journals and has co-authored the book Living with Drink: Women Who Live with Problem Drinkers (1998).

Max J. Birchwood is Director of the Early Intervention Service and Director of Research and Development for Northern Birmingham Mental Health Trust, and Professor of Mental Health at the University of Birmingham, UK. His clinical and research interests have centred around the development of methods of promoting individuals' control over their psychotic symptoms, including the application of cognitive therapy to psychotic symptoms, as in acute psychosis, and the recognition and control of early warning signs of relapse. He has published widely in these areas and is a prominent figure within this field. His books include Psychological Management of Schizophrenia (1994), Cognitive Therapy for Hallucinations, Delusions and Paranoia (1996), Early Intervention in Psychosis (2000) and Schizophrenia (2001). He is currently involved in the development of community-based early intervention for people with psychosis across the UK and is patron to the National Schizophrenia Fellowship in the UK.

Kim T. Mueser is a Professor in the Departments of Psychiatry and Community and Family Medicine at the Dartmouth Medical School in New Hampshire, USA. He is an active contributor to research and the development of clinical methods for the treatment of comorbid severe mental illness and substance use, has published numerous articles within this area, and provides research consultancy/advice to a number of services. His clinical and research interests include research on the treatment of persons with severe mental illness, and substance use disorders, family treatment and social skills training for severe mental illness, and other aspects of psychiatric rehabilitation. He has co-authored several books, including Social Skills Training for Psychiatric Patients (1989), Coping With Schizophrenia: A Guide for Families (1994).