Co-occurring severe mental illness and substance use disorders: A review of recent research

Objective: Understanding the complex diagnostic and treatment issues posed by the co-occurrence of severe mental illness and substance use disorders h as become a necessary exercise in current psychiatric practice. The authors reviewed research studies from the past six years that have contributed to our knowledge about effective assessment, diagnosis, course of illness, an d treatment approaches. Research on special populations, including women, p ersons infected with HIV, and violent patients, is highlighted. Methods: Ps ycINFO, Silver Platter, and MEDLINE were used to search for English-languag e studies published in the United States and other countries. To augment th e search, selected bibliographies were reviewed with a focus on clinical st andards. Information was sought on epidemiology, screening and assessment s trategies, course of illness, models of treatment delivery, and cost of car e. Results and conclusions: Although estimates of the prevalence of substan ce use disorders vary by population, a higher prevalence among persons with severe mental illness has been confirmed. Routine screening for and assess ment of substance use disorders among persons with severe mental illness ha s become the accepted standard of care. The course of severe mental illness is negatively influenced by a substance use disorder, and an integrated ap proach to the treatment of both disorders is generally accepted to be the m ost promising treatment strategy. Components of this strategy include harm reduction, treatment in stages, motivational interviewing, cognitive-behavi oral interventions, and modified 12-step self-help groups.