Dandenong

1. Engagement:

Engaging patients in dialogue about the relationships between their drug use and psychotic illness is a challenging but fundamental step.
Engagement is best achieved at the individual level, whether by a doctor, case manager or other clinician and depends on clinicians exploring and acknowledging the reasons that patients with psychotic illness use drugs. Although dependency is sometimes a feature of cannabis use, people also use it because it makes them feel good or different in some way.

To some extent, drug use involves a conscious decision that the perceived benefits outweigh the potential disadvantages. Many clinicians, carers and families have difficulty accepting this concept, but it is fundamental to intervention.

Failure to engage patients with psychosis who use drugs often represents a lack of effective dialogue. Patients learn not to discuss their drug use, as it is often met with a judgmental, punitive or simplistic view that it has only disadvantages and must cease.

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2. Groupwork:

An open, informal group discussion about drug use and psychosis raises the issue of making informed choices about drug use.
Unlike many group programs for drug users, this group allows explicit discussion of the pros and cons of drug use.
Not all participants in the group proceed immediately to active treatment of drug use. Some, however, return to seek treatment at a later time after contemplating the issues that have been raised.

The informal group allows participants to realise they are not unique in contemplating a change in their drug use. Exposure to peers can be very influential and also provides additional information on the financial, social and health costs of drug use.

Such groups have been criticised as leading to increased drug use through mere discussion of the topic. However, there is no evidence that this has occurred. Some simple housekeeping rules ensure the groups are not associated with dealing in drugs.

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3. Individual Treatment:

Tailored treatment for patients with psychosis who abuse drugs provides treatment through a series of eight to 10 individualised consultations.

Assessment
The CAUSE (Cannabis Amount Used and Symptom Evaluation) and CUES (Cannabis Use Effects Survey) self-report instruments are used initially to define the type and extent of use, the reasons for use and the consequences. They provide clues on effective interventions, as well as establishing a basis for discussion. The instruments are used repeatedly to monitor any changes in cannabis use.

Review of medication
Optimising antipsychotic and other medication may help reduce levels of distress and remove some of the perceived benefits of cannabis use. For example, agitation, anxiety and insomnia are common in people who have a psychotic illness that is less than optimally treated. Contrary to common beliefs, it has been rare for patients to report that they use cannabis to counteract the adverse side effects of antipsychotic medications.

Cognitive therapy – making choices
Cognitive strategies are used to address the issue of making choices about drug use. Patients are encouraged to accept that they have some control over their use of cannabis and other drugs, and need to weigh the positive and negative aspects. Cognitive therapy introduces doubt about whether current choices are appropriate.

Social interventions
Alternative behaviours to replace drug use are explored, looking at social outlets, level of support and aspects of premorbid functioning that might be reinvigorated. Restoration of educational or vocational activity is a priority, particularly in young people.

Family, carers and partners
Involvement of family members, other carers and partners can be a key element in treatment. They can be invaluable in influencing behaviour and providing support. Engagement of these groups is particularly important if they, too, use cannabis or other drugs. A special program for carers has been developed.

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Drugs other than cannabis
Alcohol abuse is less common than cannabis use but can be an important complicating factor in psychotic illnesses. Alcohol abuse is more commonly implicated in the affective psychoses including psychotic depression and bipolar disorder.

Heroin withdrawal can exacerbate psychotic symptoms.

Amphetamines are well recognised as a cause of short-term drug-induced psychosis and for their capacity to exacerbate pre-existing psychotic illness.

Ecstasy use tends to be associated with particular social situations and groups.

Standard drug and alcohol interventions are used to address these aspects of drug use, with a focus on harm minimisation.

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Go to Residential Programmes Page

Dandenong Dual Diagnosis

Principles:

1. Engagement:

2. Groupwork:

3. Individual Treatment: