Behavioral therapy helps mentally ill drug addicts

By Martha Kerr

NEW YORK (Reuters Health) – 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.