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Psychosis and comorbid substance misuse: integrated motivational interviewing and cognitive behavioural therapy reduces alcohol intake

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Question: Is integrated motivational interviewing and cognitive behavioural therapy (CBT) an effective addition to standard care for people with psychosis and a comorbid substance use problem?

Patients: 327 patients aged above 16 years with schizophrenia, schizophreniform disorder or schizoaffective disorder with a DSM-IV diagnosis of dependence on drugs, alcohol or both. Weekly alcohol use or illicit drug use of more than the recommended number of units for men or women in the UK.

Setting: Mental health trusts in Manchester and London, UK.

Intervention: Up to 26 individual therapy sessions over 12 months in location of patient's choice. Intervention included motivation building and development of a plan for change including identifying and increasing awareness of high-risk situations and warning signs for substance use lapse or relapse, and coping with psychosis and mental health problems.

Outcomes: Primary: death from any cause or admission to hospital for a reason related to psychosis in the 12 months after completion of therapy as determined from case notes. Secondary: frequency and amount of substance use through self-report with small proportion validated through hair sample analysis; readiness to change …

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