Insights into integrated treatment for dual diagnosis : a case study

Abstract

Dual diagnosis of co-occurring substance use disorders (SUD) and psychotic disorders are highly prevalent, and associated with more severe psychotic symptoms, worse treatment outcome, and worse treatment compliance. Studies have shown that an integrated treatment approach using Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) for dual diagnosis patients have shown promising results. However there is a need for more research on viable treatment options, especially research that does not exclude individuals that have active psychotic symptoms, or who are actively using substances. This mixed-methods case study aimed to evaluate the effectiveness of an integrated treatment approach using MI and CBT for dual diagnosis patients with active psychotic and other co-occurring disorders. The study had no exclusion criteria, it detailed the case histories of eight participants and used both quantitative and qualitative measures to evaluate the treatment outcomes. Despite experiencing psychotic symptoms, participants had a high attendance rate for both group sessions (75%) and individual sessions (86%). Qualitative data analyzed using thematic analysis revealed five themes and 12 sub-themes that provided valuable insight into the participants' experience of the treatment and areas for improvement. These findings suggest that individuals with a dual diagnosis should not be excluded from treatment because of active psychotic symptoms or substance use, but rather additional factors, such as the therapeutic relationship, should be considered. Keywords: dual diagnosis, psychotic disorders, substance use disorder, cognitive behavioral therapy, motivational interviewing, integrated treatment