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Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study)

Cluster randomised trial

Health Service Research Department, Institute of Psychiatry, King’s College London and Department of Mental Health Sciences, University College London

GRAHAM THORNICROFT, SARAH AFUWAPE and MORVEN LEESE

Health Service Research Department, Institute of Psychiatry, London

IAN R. WHITE

Medical Research Council Biostatistics Unit, Cambridge

ELIZABETH HUGHES

Health Service Research Department, Institute of Psychiatry, London

SHAMIL WANIGARATNE

Department of Psychology, Institute of Psychiatry, London

HELEN MILES

Department of Psychology, Institute of Psychiatry, London, and Trevor Gibbens Medium Secure Unit, West Kent National Health Service and Social Care Trust, Maidstone

TOM CRAIG

Health Service Research Department, Institute of Psychiatry, London, UK

Correspondence: Dr Sonia Johnson, Department of Mental Health Sciences, University College London, 2nd Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Email: s.johnson{at}ucl.ac.uk

Declaration of interest None.

A cluster randomised controlled trial was used to investigate the effectiveness of training staff in 13 London community mental health teams (CMHTs) to deliver substance misuse interventions to patients with psychosis and comorbid substance misuse (‘dual diagnosis’). The primary hypotheses, which were that experimental group patients would spend fewer daysin hospital over 18 months of follow-up and show reduced alcohol and drug consumption, were not confirmed, although confidence intervals were wide for some outcomes. Current UK policy guidance advocates training CMHT professionals to deliver dual diagnosis interventions, but the effectiveness of this strategy has not so far been demonstrated.

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