In general, if a person is well maintained on medication for their psychotic disorder, then management for AOD use should proceed as usual. Although AOD workers may feel daunted at the prospect of treating this often severe and complex clinical group, it is crucial to remember that treatment and care should reflect a person’s needs and preferences, whilst taking into account the evidence base.
People with co-occurring psychotic spectrum and AOD use disorders should have the opportunity to participate and make informed choices about their treatment, in consultation and partnership with their health care providers [778]. UK and Canadian guidelines on the management of co-occurring psychosis and AOD use recommend that, when planning treatment, workers take into account the severity of both disorders, the person’s social and treatment context, and their readiness to change [778].
There are several options available for the treatment of co-occurring psychotic disorders and AOD use, including psychotherapy, pharmacotherapy, ECT, e-health interventions, physical activity, and complementary and alternative therapies. Clinical guidelines in Australia and internationally currently recommend the use of integrated treatment programs addressing both psychosis and AOD use, and suggest that a combination of antipsychotic pharmacotherapy with psychosocial interventions focused on AOD use may produce the best outcomes [444, 778, 779, 942]. The evidence base surrounding each of these approaches is discussed below.