The British Journal of Psychiatry (2004) 185: 85
© 2004 The Royal College of Psychiatrists
Substance Misuse in Psychosis. Approaches to Treatment and Service Delivery
Peter Haddad
Consultant Psychiatrist, Cromwell House, Bolton, Salford and Trafford
Mental Health Partnership, Eccles M30 0GT, UK
Edited by Hermine L. Graham, Alex Copello, Max J. Birchwood & Kim
T. Mueser. Chichester: Wiley. 2003. 420 pp. £65.00 (hb). ISBN 0 471
49229 9
The high prevalence of alcohol and drug misuse in those with psychiatric
illness is apparent to all who work within adult psychiatry. Traditionally,
mental health and addiction services have operated in parallel. Differences
between the two services in terms of organisation, geographical location and
philosophy of care have often meant that patients have fallen between the two,
leading to frustration for patients, families and staff. The past 10 years
have seen increased understanding of the reasons for this comorbidity, the
development of innovative integrated treatment services and the introduction
of new treatments for substance misuse. This book provides a comprehensive
review of these developments.
The book is divided into five parts. The first serves as an introduction,
and begins with two chapters on the epidemiology of substance misuse in
psychosis and the temporal relationship between the two. This is followed by
three excellent chapters looking at family, social and cognitive
conceptualisations, the first of which highlights the relationship between
substance misuse in psychosis and the patient’s family and social
networks, including the role of expressed emotion. The sociological
perspective that follows makes some interesting points in relation to stigma
and the negative attitudes held not only by the public but also by clinicians
managing this group of patients. In the first part’s final chapter,
Hermine L. Graham emphasises the importance of a cognitive formulation in
managing patients, and how it can be used to generate hypotheses that can be
tested and act as a guide for treatment interventions.
Part 2 reviews integrated service models, including community-based and
inpatient treatment programmes. Examples are provided from the USA and the UK,
including the Combined Psychosis and Substance Use (COMPASS) programme in
north Birmingham. Part 3 considers assessment and treatment approaches such as
cognitive–behavioural therapy, group therapy and family interventions.
There is a single chapter on pharmacological approaches, which, although well
written, is too short, with the result that many key areas are skimmed over.
The editors should consider expanding this chapter in a future edition. Part 4
considers the needs of special populations, including the homeless and those
with HIV/AIDS. Part 5 examines treatment outcome studies and looks towards
future developments.
Over forty authors, mainly from the USA and the UK, have contributed. The
editors have ensured that throughout the material remains clinically relevant,
and many chapters employ illustrative case reports to good effect. This is a
well-planned and well-written book, and I recommend it.
