This clinical guideline covers the assessment and management of adults and young people (aged 14 years and older) who have a clinical diagnosis of psychosis (schizophrenia, bipolar disorder or other affective psychosis) and coexisting substance misuse (harmful use of any psychotropic substance including alcohol and legal or illicit drugs).

Around 40% of people experiencing psychosis also misuse substances at some point in their lives, which can lead to serious health and social problems for the person and complicate their treatment.

Although separate NICE guidelines have been developed for the management of schizophrenia, bipolar disorder and drug and alcohol misuse, the importance of this new guideline on psychosis and substance misuse is that it offers advice on how to integrate treatment for people with these commonly coexisting conditions.

The guideline includes comprehensive reviews of assessment, care pathways and service delivery models, psychological and pharmacological interventions for both conditions, and treatment and services for young people. There is also an extensive review of the experience of care.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINE
  • 1.2. THE NATIONAL PSYCHOSIS WITH COEXISTING SUBSTANCE MISUSE GUIDELINE
• 2. PSYCHOSIS WITH COEXISTING SUBSTANCE MISUSE
  • 2.1. INTRODUCTION
  • 2.2. INCIDENCE AND PREVALENCE
  • 2.3. COURSE AND PROGNOSIS
  • 2.4. AETIOLOGY
  • 2.5. DIAGNOSIS
  • 2.6. TREATMENT AND MANAGEMENT IN THE NHS
  • 2.7. ECONOMIC COSTS
• 3. METHOD USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. STAKEHOLDER CONTRIBUTIONS
  • 3.8. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. PERSONAL ACCOUNTS
  • 4.3. PERSONAL ACCOUNTS—FAMILIES/CARERS
  • 4.4. REVIEW OF QUALITATIVE RESEARCH
  • 4.5. QUALITATIVE ANALYSIS
  • 4.6. OVERALL SUMMARY
  • 4.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 4.8. RECOMMENDATIONS
• 5. ASSESSMENT AND CARE PATHWAYS
  • 5.1. INTRODUCTION
  • 5.2. PRINCIPLES UNDERPINNING CARE PATHWAYS
  • 5.3. PRIMARY CARE
  • 5.4. SECONDARY CARE (GENERAL MENTAL HEALTH SERVICES)
  • 5.5. SECONDARY MENTAL HEALTHCARE REFERRAL TO SPECIALIST SUBSTANCE MISUSE SERVICES
  • 5.6. INPATIENT AND RESIDENTIAL SERVICES
  • 5.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 5.8. RECOMMENDATIONS
• 6. SERVICE DELIVERY MODELS
  • 6.1. INTRODUCTION
  • 6.2. INTEGRATED SERVICE MODELS
  • 6.3. STAFFED ACCOMMODATION
  • 6.4. INPATIENT CARE
• 7. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. EVIDENCE REVIEW
  • 7.3. FROM EVIDENCE TO RECOMMENDATIONS (PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS)
  • 7.4. RECOMMENDATIONS
• 8. PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. EVIDENCE REVIEW
  • 8.3. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.4. RECOMMENDATIONS
• 9. YOUNG PEOPLE WITH PSYCHOSIS AND COEXISTING SUBSTANCE MISUSE
  • 9.1. INTRODUCTION
  • 9.2. PREVALENCE
  • 9.3. IMPACT OF SUBSTANCE MISUSE ON OUTCOME IN PSYCHOSIS
  • 9.4. ASSESSMENT AND DIAGNOSIS
  • 9.5. SERVICE CONFIGURATION AND CARE PATHWAYS
  • 9.6. EARLY INTERVENTION IN PSYCHOSIS SERVICES
  • 9.7. SPECIALIST SUBSTANCE MISUSE SERVICES FOR YOUNG PEOPLE
  • 9.8. INTERVENTIONS
  • 9.9. FROM EVIDENCE TO RECOMMENDATIONS
  • 9.10. RECOMMENDATIONS
• 10. SUMMARY OF RECOMMENDATIONS
  • 10.1. PRINCIPLES OF CARE
  • 10.2. RECOGNITION OF PSYCHOSIS WITH COEXISTING SUBSTANCE MISUSE
  • 10.3. PRIMARY CARE
  • 10.4. SECONDARY CARE MENTAL HEALTH SERVICES
  • 10.5. SUBSTANCE MISUSE SERVICES
  • 10.6. INPATIENT MENTAL HEALTH SERVICES
  • 10.7. STAFFED ACCOMMODATION
  • 10.8. SPECIFIC ISSUES FOR YOUNG PEOPLE WITH PSYCHOSIS AND COEXISTING SUBSTANCE MISUSE
• APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GDG MEMBERS
  • APPENDIX 3. STAKEHOLDERS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 4. EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5. RESEARCHERS CONTACTED TO REQUEST FURTHER INFORMATION ABOUT PUBLISHED OR UNPUBLISHED EVIDENCE
  • APPENDIX 6. ANALYTIC FRAMEWORK AND REVIEW QUESTIONS
  • APPENDIX 7. SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
  • APPENDIX 8. METHODOLOGY CHECKLIST TEMPLATE FOR CLINICAL STUDIES AND REVIEWS
  • APPENDIX 9. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMIC EVIDENCE
  • APPENDIX 10. METHODOLOGY CHECKLIST TEMPLATE FOR ECONOMIC STUDIES
  • APPENDIX 11. EVIDENCE TABLES FOR ECONOMIC STUDIES
  • APPENDIX 12. HIGH-PRIORITY RESEARCH RECOMMENDATIONS
  • APPENDIX 13. CLINICAL STUDY CHARACTERISTICS TABLES
  • APPENDIX 14. CLINICAL EVIDENCE FOREST PLOTS
  • APPENDIX 15. GRADE EVIDENCE PROFILE TABLES
  • APPENDIX 16. COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 17. ECONOMIC EVIDENCE PROFILES
  • APPENDIX 18. ECONOMIC EVIDENCE – COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 19. ECONOMIC PLAN
  • APPENDIX 20. CLINICAL REVIEW PROTOCOLS
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).