Twelve-step programs beneficial in comorbid substance use, psychotic disorders

Patients with comorbid substance use and psychotic disorders do indeed benefit from standard substance use treatment that is not integrated with their psychiatric diagnosis, including both 12-step and cognitive-behavioral programs.

The finding validates the standard, nonintegrated treatment that is currently most prevalent among this cohort, especially veterans, according to an analysis in Schizophrenia Research.

The study, by Matthew Tyler Boden, Ph.D., and Rudolf Moos, Ph.D., both of the Center for Health Care Evaluation at Veterans Affairs Palo Alto (Calif.) Health Care System, looked at 236 male patients with comorbid substance use and non-substance–related psychotic disorders.

All patients sought treatment at one of 15 residential substance use disorder programs affiliated with the Department of Veterans Affairs (Schizophr. Res. 2013;146:28-33).

The mean age was 41 years; 50% were white, 44.5% were black, and the average reported education level among the cohort was 13 years.

Most of the patients (62.7%) had schizophrenia; the remainder had a psychotic disorder related to affect, such as schizoaffective disorder.

According to the authors, patients in cognitive-behavioral programs participated in small therapy and relapse prevention groups. They also attended cognitive, behavioral, and abstinence skills training groups.

The 12-step programs, on the other hand, encouraged patients to see themselves as addicts or alcoholics, and to acknowledge that they were powerless or had little control over abused substances. These self-help programs also encouraged the patients to adhere to the treatment goal of abstinence, wrote the authors.

Both groups experienced similar results in the near term, in what the investigators called "proximal" outcomes: In both groups, active coping significantly increased and avoidant coping significantly decreased from initiation to discharge.

Indeed, it wasn’t the type of program, but the degree of patient satisfaction that predicted results.

"Patients who perceived the treatment milieu more positively (greater support, spontaneity, spirituality, personal problem orientation) and reported more satisfaction tended to show better proximal outcomes, especially in terms of self-efficacy and approach coping," the researchers noted.

In turn, "patients who had better proximal outcomes at discharge (especially more self-efficacy and less reliance on avoidance coping) tended to show fewer psychiatric symptoms and less substance use at 1 year," they wrote.

The investigators noted that patients who participated in the 12-step programs experienced better 5-year substance use outcomes.

The study could not assess the mechanisms that led to improvement, nor could it accurately compare the two different program modalities, the researchers said. Additionally, the study was hampered by the lack of a control group, which "limits our ability to determine whether changes were due to treatment or to natural improvement over time."

Finally, they wrote that their population of male veterans might also limit the study’s generalizability to other cohorts, such as women and nonveteran patients with comorbid substance use and psychotic disorders.

"Although experts are consistent in their recommendations for treating [substance use disorder/psychotic disorder] patients with an integrated approach, and integrated approaches are effective, our results suggest that [these] patients may benefit from standard [substance use disorder] treatments, even those that may not directly address their psychiatric disorders," the authors wrote.

"These findings suggest that [substance use disorder] treatment programs could benefit [substance use disorder/psychotic disorder] patients by allocating more resources to enhance positive reactions to treatment and improve proximal outcomes, such as self-efficacy and avoidant coping," they added.

The study was supported by the Veterans Health Administration. The authors declared having no conflicts of interest.

Patients with comorbid substance use and psychotic disorders do indeed benefit from standard substance use treatment that is not integrated with their psychiatric diagnosis, including both 12-step and cognitive-behavioral programs.

The finding validates the standard, nonintegrated treatment that is currently most prevalent among this cohort, especially veterans, according to an analysis in Schizophrenia Research.

The study, by Matthew Tyler Boden, Ph.D., and Rudolf Moos, Ph.D., both of the Center for Health Care Evaluation at Veterans Affairs Palo Alto (Calif.) Health Care System, looked at 236 male patients with comorbid substance use and non-substance–related psychotic disorders.

All patients sought treatment at one of 15 residential substance use disorder programs affiliated with the Department of Veterans Affairs (Schizophr. Res. 2013;146:28-33).

The mean age was 41 years; 50% were white, 44.5% were black, and the average reported education level among the cohort was 13 years.

Most of the patients (62.7%) had schizophrenia; the remainder had a psychotic disorder related to affect, such as schizoaffective disorder.

According to the authors, patients in cognitive-behavioral programs participated in small therapy and relapse prevention groups. They also attended cognitive, behavioral, and abstinence skills training groups.

The 12-step programs, on the other hand, encouraged patients to see themselves as addicts or alcoholics, and to acknowledge that they were powerless or had little control over abused substances. These self-help programs also encouraged the patients to adhere to the treatment goal of abstinence, wrote the authors.

Both groups experienced similar results in the near term, in what the investigators called "proximal" outcomes: In both groups, active coping significantly increased and avoidant coping significantly decreased from initiation to discharge.

Indeed, it wasn’t the type of program, but the degree of patient satisfaction that predicted results.

"Patients who perceived the treatment milieu more positively (greater support, spontaneity, spirituality, personal problem orientation) and reported more satisfaction tended to show better proximal outcomes, especially in terms of self-efficacy and approach coping," the researchers noted.

In turn, "patients who had better proximal outcomes at discharge (especially more self-efficacy and less reliance on avoidance coping) tended to show fewer psychiatric symptoms and less substance use at 1 year," they wrote.

The investigators noted that patients who participated in the 12-step programs experienced better 5-year substance use outcomes.

The study could not assess the mechanisms that led to improvement, nor could it accurately compare the two different program modalities, the researchers said. Additionally, the study was hampered by the lack of a control group, which "limits our ability to determine whether changes were due to treatment or to natural improvement over time."

Finally, they wrote that their population of male veterans might also limit the study’s generalizability to other cohorts, such as women and nonveteran patients with comorbid substance use and psychotic disorders.

"Although experts are consistent in their recommendations for treating [substance use disorder/psychotic disorder] patients with an integrated approach, and integrated approaches are effective, our results suggest that [these] patients may benefit from standard [substance use disorder] treatments, even those that may not directly address their psychiatric disorders," the authors wrote.

"These findings suggest that [substance use disorder] treatment programs could benefit [substance use disorder/psychotic disorder] patients by allocating more resources to enhance positive reactions to treatment and improve proximal outcomes, such as self-efficacy and avoidant coping," they added.

The study was supported by the Veterans Health Administration. The authors declared having no conflicts of interest.

Patients with comorbid substance use and psychotic disorders do indeed benefit from standard substance use treatment that is not integrated with their psychiatric diagnosis, including both 12-step and cognitive-behavioral programs.

The finding validates the standard, nonintegrated treatment that is currently most prevalent among this cohort, especially veterans, according to an analysis in Schizophrenia Research.

The study, by Matthew Tyler Boden, Ph.D., and Rudolf Moos, Ph.D., both of the Center for Health Care Evaluation at Veterans Affairs Palo Alto (Calif.) Health Care System, looked at 236 male patients with comorbid substance use and non-substance–related psychotic disorders.

All patients sought treatment at one of 15 residential substance use disorder programs affiliated with the Department of Veterans Affairs (Schizophr. Res. 2013;146:28-33).

The mean age was 41 years; 50% were white, 44.5% were black, and the average reported education level among the cohort was 13 years.

Most of the patients (62.7%) had schizophrenia; the remainder had a psychotic disorder related to affect, such as schizoaffective disorder.

According to the authors, patients in cognitive-behavioral programs participated in small therapy and relapse prevention groups. They also attended cognitive, behavioral, and abstinence skills training groups.

The 12-step programs, on the other hand, encouraged patients to see themselves as addicts or alcoholics, and to acknowledge that they were powerless or had little control over abused substances. These self-help programs also encouraged the patients to adhere to the treatment goal of abstinence, wrote the authors.

Both groups experienced similar results in the near term, in what the investigators called "proximal" outcomes: In both groups, active coping significantly increased and avoidant coping significantly decreased from initiation to discharge.

Indeed, it wasn’t the type of program, but the degree of patient satisfaction that predicted results.

"Patients who perceived the treatment milieu more positively (greater support, spontaneity, spirituality, personal problem orientation) and reported more satisfaction tended to show better proximal outcomes, especially in terms of self-efficacy and approach coping," the researchers noted.

In turn, "patients who had better proximal outcomes at discharge (especially more self-efficacy and less reliance on avoidance coping) tended to show fewer psychiatric symptoms and less substance use at 1 year," they wrote.

The investigators noted that patients who participated in the 12-step programs experienced better 5-year substance use outcomes.

The study could not assess the mechanisms that led to improvement, nor could it accurately compare the two different program modalities, the researchers said. Additionally, the study was hampered by the lack of a control group, which "limits our ability to determine whether changes were due to treatment or to natural improvement over time."

Finally, they wrote that their population of male veterans might also limit the study’s generalizability to other cohorts, such as women and nonveteran patients with comorbid substance use and psychotic disorders.

"Although experts are consistent in their recommendations for treating [substance use disorder/psychotic disorder] patients with an integrated approach, and integrated approaches are effective, our results suggest that [these] patients may benefit from standard [substance use disorder] treatments, even those that may not directly address their psychiatric disorders," the authors wrote.

"These findings suggest that [substance use disorder] treatment programs could benefit [substance use disorder/psychotic disorder] patients by allocating more resources to enhance positive reactions to treatment and improve proximal outcomes, such as self-efficacy and avoidant coping," they added.

The study was supported by the Veterans Health Administration. The authors declared having no conflicts of interest.