Centre for Brain and Mental Health Research, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
Addict Behav. 2009 Oct;34(10):852-8. doi: 10.1016/j.addbeh.2009.02.002. Epub 2009 Feb 23.
Substance misuse among people with severe mental disorders is very common and has been associated with a number of adverse outcomes. Most trials among people with severe mental disorders have reported general substance misuse outcomes and have argued that longer treatments are likely to be more effective. Such studies have not specifically compared intervention effectiveness for alcohol vs. cannabis misuse. The present paper reports findings from a synthesis of datasets from three randomized controlled trials (N=248) comparing brief (1-session advice or motivational interviewing, MI) and extended (10 sessions MI/cognitive-behaviour therapy; CBT) interventions for substance misuse among people with psychosis or major depression and outcomes are reported separately for alcohol and cannabis use. Whilst there were comparable rates of reduction in alcohol consumption for the BI and intensive MI/CBT, BI tended to be associated with less reduction in cannabis use. A stepped care approach for substance misuse in people with severe mental disorders may help to improve cannabis outcomes, including monitoring of both mental health and substance misuse domains, with interventions stepped up or down according to treatment response. Future studies should evaluate the effectiveness of stepped care approaches.
精神疾病患者药物滥用非常普遍，并与许多不良后果相关。大多数精神疾病患者的试验报告了一般药物滥用结果，并认为延长治疗可能更有效。这些研究没有专门比较酒精与大麻滥用干预的有效性。本文报告了对三项随机对照试验（N=248）数据集综合分析的结果，这些试验比较了针对精神病或重度抑郁症患者药物滥用的简短（1 次咨询或动机性访谈，MI）和扩展（10 次 MI/认知行为治疗；CBT）干预措施，酒精和大麻使用的结果分别报告。尽管 BI 和强化 MI/CBT 对酒精摄入量的减少相当，但 BI 往往与大麻使用量的减少较少相关。针对严重精神障碍患者药物滥用的分级护理方法可能有助于改善大麻的结果，包括监测心理健康和药物滥用两个领域，根据治疗反应逐步增加或减少干预措施。未来的研究应评估分级护理方法的有效性。
