In summary, existing research suggests that there is no ‘one size fits all’ approach for treating comorbid psychotic spectrum and AOD use disorders , suggesting combinations of different therapeutic approaches may be necessary for each individual client. Further, therapist flexibility is incredibly important in the treatment of this group.
Box 14 illustrates the continuation of case study B, following Nick’s story after contact was made with the local AOD service for an assessment.
Box 14: Case study B: Treating comorbid psychosis and AOD use: Nick’s story continued
Nick’s assessment with the AOD worker opened the door for a collaborative approach to his treatment with the community mental health team. The case manager and AOD worker organised an appointment with Nick’s psychiatrist to discuss a treatment plan, taking into account both his mental health and AOD use. They also organised for Nick to be seen by a medical doctor to ascertain whether there were any physical conditions that needed to be taken into consideration. With Nick, a plan was devised to address his most pressing needs. This coordinated approach to Nick’s care allowed for his needs to be comprehensively addressed and included alterations to his medication regime, psychotherapy, and ongoing support from his case manager. Several physical health problems were identified, leading him to receive treatment for elevated blood pressure. He also attended a dentist for the first time in many years and had some teeth filled and others extracted.
The treatment goals for Nick in the long term were for him to live in supported accommodation, and he began part time work in a supermarket. Improvements in Nick’s mental health and AOD use led to improved social functioning, allowing him to engage in a range of activities organised for the supported living complex, which became his permanent home. Nick continued to express bizarre ideas and still hears voices, but he is able to cope better with these phenomena.
- Chronic illness does not equate to untreatable illness. Psychotherapy may provide symptom relief and improved quality of life, and all treatment approaches need to be carefully integrated.
- Medication compliance needs long-term attention.
- Physical health is often overlooked.
- A holistic approach, assessing a person’s accommodation and employment needs in addition to their mental, physical, and AOD use disorders, is vital.