Treating substance abuse in the context of severe and persistent mental illness - Clinicians' perspectives

Kate B. Carey, Daniel M. Purnine, Stephen A. Maisto, Michael P. Carey, Jeffrey S. Simons

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population. (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)189-198
Number of pages10
JournalJournal of Substance Abuse Treatment
Volume19
Issue number2
DOIs
StatePublished - Sep 1 2000

Keywords

  • Clinician perspective
  • Dual diagnosis
  • Substance abuse
  • Treatment

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

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