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Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial.

Barrowclough C, Haddock G, Wykes T, Beardmore R, Conrod P, Craig T, Davies L, Dunn G, Eisner E, Lewis S, Moring J, Steel C, Tarrier N - BMJ (2010)

Bottom Line: Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320).There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm.This approach does reduce the amount of substance used for at least one year after completion of therapy.

View Article: PubMed Central - PubMed

Affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK. christine.barrowclough@manchester.ac.uk

ABSTRACT

Objectives: To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem.

Design: Two centre, open, rater blind randomised controlled trial.

Setting: Secondary care in the United Kingdom.

Participants: 327 patients with a clinical diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs, alcohol, or both according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

Intervention: The intervention was integrated motivational interviewing and cognitive behavioural therapy plus standard care, which was compared with standard care alone. Phase one of therapy-"motivation building"-concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two-"action"-supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year.

Main outcome measures: The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy. Secondary outcomes were frequency and amount of substance use (assessed using the timeline followback method), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, and global assessment of functioning and deliberate self harm at 12 and 24 months, with additional timeline followback assessments at 6 and 18 months. Analysis was by intention to treat and robust treatment effect estimates were produced.

Results: 327 participants were randomly allocated to either the intervention (n=164) or treatment as usual (n=163). At 24 months, 326 (99.7%) were assessed on the primary outcome and 246 (75.2%) on the main secondary outcomes. Treatment had no beneficial effect on hospital admissions or death during follow-up, with 23.3% (38/163) of the therapy group and 20.2% (33/163) of controls deceased or admitted (adjusted odds ratio 1.16, 95% confidence interval 0.68 to 1.99; P=0.579). Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse, but did have a statistically significant effect on amount used per substance using day (adjusted ORs for main substance 1.50, 95% CI 1.08 to 2.09; P=0.016; and all substances 1.48, 95% CI 1.07 to 2.05; P=0.017). Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320). There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm.

Conclusions: Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome in terms of hospitalisation, symptom outcomes, or functioning. This approach does reduce the amount of substance used for at least one year after completion of therapy.

Trial registration: Current Controlled Trials: ISRCTN14404480.

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Related in: MedlinePlus

Fig 2 Predicted probabilities of being in each of the five change in substance use categories (change from baseline in average daily amount of main substance) for therapy and control groups, based on a repeated measures marginal ordinal regression model that allowed for baseline covariates
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fig2: Fig 2 Predicted probabilities of being in each of the five change in substance use categories (change from baseline in average daily amount of main substance) for therapy and control groups, based on a repeated measures marginal ordinal regression model that allowed for baseline covariates

Mentions: For percentage days abstinent from substance use (table 3), there was no difference between the therapy group and the control group for either main substance (adjusted coefficient estimated using random effects 1.28, 95% CI −5.88 to 8.45; P=0.725) or all substances (4.18, 95% CI −2.63 to 11.00; P=0.229). However, the integrated therapy was found to have a statistically significant effect on the amount of substance used per substance using day (table 6, fig 2) in terms of both main substance (adjusted OR estimated using ordinal regression 1.50, 95% CI 1.08 to 2.09; P=0.016) and all substances (1.48, 95% CI 1.07 to 2.05; P=0.017). Thus for the therapy group, the odds of being in one of the more abstinent groups versus one of the less abstinent groups are 1.50 times higher than for the control group for main substance (1.48 higher for all substances), given the other variables in the model are held constant.


Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial.

Barrowclough C, Haddock G, Wykes T, Beardmore R, Conrod P, Craig T, Davies L, Dunn G, Eisner E, Lewis S, Moring J, Steel C, Tarrier N - BMJ (2010)

Fig 2 Predicted probabilities of being in each of the five change in substance use categories (change from baseline in average daily amount of main substance) for therapy and control groups, based on a repeated measures marginal ordinal regression model that allowed for baseline covariates
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2991241&req=5

fig2: Fig 2 Predicted probabilities of being in each of the five change in substance use categories (change from baseline in average daily amount of main substance) for therapy and control groups, based on a repeated measures marginal ordinal regression model that allowed for baseline covariates
Mentions: For percentage days abstinent from substance use (table 3), there was no difference between the therapy group and the control group for either main substance (adjusted coefficient estimated using random effects 1.28, 95% CI −5.88 to 8.45; P=0.725) or all substances (4.18, 95% CI −2.63 to 11.00; P=0.229). However, the integrated therapy was found to have a statistically significant effect on the amount of substance used per substance using day (table 6, fig 2) in terms of both main substance (adjusted OR estimated using ordinal regression 1.50, 95% CI 1.08 to 2.09; P=0.016) and all substances (1.48, 95% CI 1.07 to 2.05; P=0.017). Thus for the therapy group, the odds of being in one of the more abstinent groups versus one of the less abstinent groups are 1.50 times higher than for the control group for main substance (1.48 higher for all substances), given the other variables in the model are held constant.

Bottom Line: Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320).There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm.This approach does reduce the amount of substance used for at least one year after completion of therapy.

View Article: PubMed Central - PubMed

Affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK. christine.barrowclough@manchester.ac.uk

ABSTRACT

Objectives: To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem.

Design: Two centre, open, rater blind randomised controlled trial.

Setting: Secondary care in the United Kingdom.

Participants: 327 patients with a clinical diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs, alcohol, or both according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

Intervention: The intervention was integrated motivational interviewing and cognitive behavioural therapy plus standard care, which was compared with standard care alone. Phase one of therapy-"motivation building"-concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two-"action"-supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year.

Main outcome measures: The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy. Secondary outcomes were frequency and amount of substance use (assessed using the timeline followback method), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, and global assessment of functioning and deliberate self harm at 12 and 24 months, with additional timeline followback assessments at 6 and 18 months. Analysis was by intention to treat and robust treatment effect estimates were produced.

Results: 327 participants were randomly allocated to either the intervention (n=164) or treatment as usual (n=163). At 24 months, 326 (99.7%) were assessed on the primary outcome and 246 (75.2%) on the main secondary outcomes. Treatment had no beneficial effect on hospital admissions or death during follow-up, with 23.3% (38/163) of the therapy group and 20.2% (33/163) of controls deceased or admitted (adjusted odds ratio 1.16, 95% confidence interval 0.68 to 1.99; P=0.579). Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse, but did have a statistically significant effect on amount used per substance using day (adjusted ORs for main substance 1.50, 95% CI 1.08 to 2.09; P=0.016; and all substances 1.48, 95% CI 1.07 to 2.05; P=0.017). Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320). There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm.

Conclusions: Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome in terms of hospitalisation, symptom outcomes, or functioning. This approach does reduce the amount of substance used for at least one year after completion of therapy.

Trial registration: Current Controlled Trials: ISRCTN14404480.

Show MeSH
Related in: MedlinePlus