TREATMENT OF SUBSTANCE-ABUSE IN SEVERELY MENTALLY-ILL PATIENTS

Substance abuse is the most common comorbid complication of severe men tal illness. Current clinical research converges on several emerging p rinciples of treatment that address the scope, pace, intensity, and st ructure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatme nt, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse and mental health interventions in the same program, d) comprehensive, broad-based services to address other problems of adjustment, e) safe and protective living environments, f ) flexibility of clinicians and programs, g) stage-wise treatment to e nsure the appropriate timing of interventions, h) a longitudinal persp ective that is congruent with the chronicity of dual disorders, and i) optimism.