ABSTRACT
The high co-occurrence of schizophrenia and substance use and the significant impact on both acute risks and later outcomes, it is imperative that mental health–substance use services routinely screen for both problems. Some people with psychosis are able to maintain changes in substance use after only a motivational intervention, but most need more support. Dysphoria and substance refusal often represent particular challenges. Repetitive patterns in risk situations and prodromes may be seen in both psychosis and substance use problems. An integrated approach is required to effectively screen, assess and treat co-occurring schizophrenia and substance use, due to the close interrelationship that is typically found between these disorders. Screening instruments and motivational procedures for substance use can be adapted from ones used in alcohol and other drug services, but need to take account of the lower levels of dependence and greater cognitive dysfunction that typify this group.
