Integrating services for schizophrenia and substance abuse

Over the past decade, several studies have attempted to determine whether i ntegrating psychiatric and substance abuse treatment leads to better outcom e for patients with comorbid schizophrenia and substance use disorders. A r ecent (1999) Cochrane Review (1) analyzed the effectiveness of prospective randomized studies of integrated treatment approaches, and concluded that t here was no clear evidence for superiority of integrated treatment. This pa per describes one such integrated treatment approach, in Beth Israel Medica l Center's COPAD (Combined Psychiatric and Addictive Disorders) program. We summarize findings from an initial outcome study and a recent replication study; and describe clinical and research issues relevant to this populatio n. Our data suggests the benefits of integrated treatment for patients with addictive disorders and schizophrenia, at least with regard to treatment r etention. Clinical issues for such patients include identification of patie nts at risk, proper assessment and treatment planning, decision-making abou t mainstreaming vs. referral to specialized programs, and the importance of initial engagement and ongoing reengagement in successful treatment.