Behavioral therapy helps mentally ill drug addicts

Drug-addicted patients with severe, persistent mental illness respond well to a new behavioral approach that involves social skills training and motivational interviewing, as well as mandatory urine checks, research suggests.

The intervention is called Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS). Researchers compared this approach with Supportive Treatment for Addiction Recovery (STAR) - the usual care approach involving talk and support.

The study involved 129 stable outpatients with drug dependence from the mental health center of the University of Maryland in Baltimore. Of these, roughly 39 percent met criteria for schizophrenia, 56 percent had major affective disorders and the remainder had other severe and persistent mental illnesses.

Patients met in small groups twice a week for 6 months. The primary outcome was drug-free urine specimens at treatment sessions.

"BTSAS was significantly more effective than STAR" in the primary outcome, report Dr. Alan S. Bellack of the Veteran Affairs Maryland Health Care System in Baltimore and colleagues in the Archives of General Psychiatry.

BTSAS was also associated with better attendance at meetings and better long-term adherence to the program than STAR. Quality of life and financial status was better and the need for hospitalization decreased with the new treatment approach.

"Ours is the first multifaceted behavioral treatment for persons with dual disorders: drug dependence and serious mental illness. Other behavioral treatments focus primarily on less impaired persons and those without dual disorders," Bellack told Reuters Health.

"Our treatment is primarily suitable for people with current or recent drug dependence and serious mental illness, including schizophrenia, bipolar disorder, and persistent, debilitating depression or anxiety disorders. We are currently developing a parallel intervention for people with serious mental illness and alcohol abuse/dependence," the researcher added.

SOURCE: Archives of General Psychiatry April 2006.