|From The Cochrane Library, Issue 3, 2003. Oxford: Update Software Ltd. All rights reserved.|
Psychosocial treatment programmes for people with both severe mental illness and substance misuse (Cochrane Review)
Ley A, Jeffery DP, McLaren S, Siegfried N
A substantive amendment to this systematic review was last made on 23 February 2000. Cochrane reviews are regularly checked and updated if necessary.
Background: Substance misuse in the context of severe mental illness can have detrimental effects. A variety of treatments exist, but the drive has been to provide programmes integrating treatment of both substance misuse and severe mental illness. Such programmes require additional resources and may require radical redesign of service delivery systems.
Objectives: To evaluate the effectiveness of treatment programmes within psychiatric care for people with problems of both substance misuse and serious mental illness.
Search strategy: Biological Abstracts (1985-1998), CINAHL (1982-1998), The Cochrane Library (Issue 3, 1998), The Cochrane Schizophrenia Group's Register of trials (August 1998), EMBASE (1980-1998), MEDLINE (1966-1998), PsycLIT (1974-1998) and Sociofile (1974-1998) were comprehensively searched. Citations of all trials were searched and further studies sought from published trials and their authors.
Selection criteria: All randomised trials of any programme of substance misuse treatment for people with serious mental illness and current problems of substance misuse.
Data collection and analysis: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were also independently extracted. For homogeneous dichotomous data the Peto odds ratio (OR), and 95% confidence intervals (CI) were calculated on an intention-to-treat basis.
Main results: Six relevant studies, four of which were small, were identified. In general, the quality of design and reporting was not high. Clinically important outcomes such as relapse of severe mental illness, violence to others, patient or carer satisfaction, social functioning and employment were not reported. There is no clear evidence supporting an advantage of any type of substance misuse programme for those with serious mental illness over the value of standard care. No one programme is clearly superior to another.
Reviewers' conclusions: The problems posed by substance misuse in the context of severe mental illness will not go away. The current momentum for integrated programmes is not based on good evidence. Implementation of new specialist substance misuse services for those with serious mental illnesses should be within the context of simple, well designed controlled clinical trials.
Citation: Ley A, Jeffery DP, McLaren S, Siegfried N. Psychosocial treatment programmes for people with both severe mental illness and substance misuse (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.
This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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File Reference: AB001088.htm