Siegfried N
Psychosis and Substance Use Project, Central Sydney Area Health Service, Rozelle Hospital, New South Wales, Australia.
Aust N Z J Psychiatry. 1998 Oct;32(5):707-17. doi: 10.3109/00048679809113127.
The aim of this paper is to critically review the literature on major mental illness and problematic substance use in order to provide clinicians and policy-makers with evidence to support proposed directions for management of the above.
The available literature was accessed using computerised databases and manual searching.
The predominantly North American-based literature is largely descriptive. Those studies which attempt empirical evaluation are limited by methodological weaknesses which include small sample sizes, short follow-up periods, inadequate measurement of substance use, lack of experimental design, and treatment drift over time. However, there is consensus among most studies regarding prevalence rates and treatment.
Problematic substance use is the most common comorbid condition among people with a major mental illness and is associated with poorer patient outcomes. There is evidence to suggest that the integration of mental health and drug and alcohol services will result in improved detection, assessment and management of comorbidity. Integration refers to the provision of comprehensive services by a single service with staff who are competent in both mental health and drug and alcohol skills. A tolerant, non-confrontational approach to substance use is most appropriate for people with a major mental illness. Treatment programs need to recognise the longitudinal nature of substance abuse and dependence. More research needs to be conducted in this field in order to establish guidelines for effective management.
本文旨在对有关重度精神疾病和物质使用问题的文献进行批判性综述，以便为临床医生和政策制定者提供证据，支持针对上述情况的管理建议方向。
通过计算机数据库检索和手工检索获取现有文献。
主要基于北美的文献大多是描述性的。那些尝试进行实证评估的研究受到方法学弱点的限制，这些弱点包括样本量小、随访期短、物质使用测量不充分、缺乏实验设计以及随着时间推移的治疗漂移。然而，大多数研究在患病率和治疗方面存在共识。
物质使用问题是重度精神疾病患者中最常见的共病情况，并且与较差的患者结局相关。有证据表明，整合心理健康与毒品和酒精服务将改善对共病的检测、评估和管理。整合是指由单一服务机构提供全面服务，其工作人员具备心理健康和毒品及酒精方面的技能。对物质使用采取宽容、非对抗性的方法最适合重度精神疾病患者。治疗方案需要认识到物质滥用和依赖的长期性。为了建立有效管理的指南，该领域需要开展更多研究。
