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First-Episode Psychosis and Co-Occurring Substance Use EVIDENCE-BASED RESOURCE GUIDE SERIES First-Episode Psychosis and Co-Occurring Substance Use Disorders Acknowledgments This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) under contract number HHSS2832017000651I/HHSS28342001T with SAMHSA, U.S. Department of Health and Human Services (HHS). Thomas Clarke served as contracting officer representative. Disclaimer The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA. Nothing in this document constitutes a direct or indirect endorsement by SAMHSA of any non-federal entity’s products, services, or policies, and any reference to non-federal entity’s products, services, or policies should not be construed as such. Public Domain Notice All material appearing in this publication is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA. Electronic Access This publication may be downloaded from http://store.samhsa.gov Recommended Citation Substance Abuse and Mental Health Services Administration: First-Episode Psychosis and Co-Occurring Substance Use Disorders. Publication No. PEP19-PL-Guide-3 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2019. Originating Office National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, Publication No. PEP19-PL-Guide-3. Nondiscrimination Notice SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad. First-Episode Psychosis and Co-Occurring Substance Use Disorders ii Acknowledgments Evidence-Based Resource Guide FOREWORD Series Overview The Substance Abuse and Mental Health Services administrators, and community members to meet Administration (SAMHSA), and specifically, the the needs of individuals at risk for, experiencing, National Mental Health and Substance Use Policy or recovering from addictions and mental illness. Laboratory, is pleased to fulfill the charge of the 21st Century Cures Act and disseminate information on An important area of concern for SAMHSA is evidence-based practices and service delivery models promoting coordinated interventions to address to prevent substance misuse and help individuals with first-episode psychosis and co-occurring substance substance use disorders, serious mental illnesses, and misuse and substance use disorders among young serious emotional disturbances get the treatment and adults. This guide will review the scientific literature, support that they need. examine emerging and best practices, determine key components of peer-reviewed models, and identify Individuals in treatment and recovery vary in many challenges and gaps in implementation. ways. They experience different mental health and substance use conditions, may have co-occurring Each guide in the series was developed through input disorders, live in diverse parts of the country, and from an expert panel made up of federal, state, and challenge a variety of socio-economic factors that non-governmental participants. The expert panel help or hinder recovery. These challenges are further provided input based on their knowledge of health complicated for individuals who are seeking help for care systems, implementation, evidence-based mental health or substance use conditions but have practices, provision of services, and policies that foster limited access to effective services. All these factors change. bring complexities to evaluating the effectiveness Panels included a unique group of accomplished of services, treatments, and supports for mental and scientists, providers, administrators from provider substance use disorders. and community organizations, federal and state policy Despite variations, substantial evidence is available makers, and persons with lived experience. to inform the types of services, treatments, and supports that reduce substance use, reduce severity One Piece of a of symptoms of mental illness, and improve Multipronged Approach individuals’ quality of life. Communities are eager to take advantage of what has been learned to help Research shows that implementing evidence-based individuals in need. practices requires a comprehensive, multi-pronged approach. This guide is one piece of an overall The Evidence-Based Resource Guide Series is a approach to implement and sustain change. Users comprehensive and modular set of resources intended are encouraged to review the SAMHSA website for to support health care providers, health care system additional tools and technical assistance opportunities. First-Episode Psychosis and Co-Occurring Substance Use Disorders 1 Evidence-Based Resource Guide Series Overview Content of the Guide Focus of the Guide This guide contains a foreword and five chapters. The chapters are The transition to adulthood can be a modular and do not need to be read in order. Each chapter is designed stressful process for young adults as to be brief and accessible to health care providers, health care system they become more self-sufficient and administrators, community members, and others working to meet the face important life decisions that can needs of individuals at risk for, experiencing, or recovering from a shape their futures. The transition substance use disorder and/or mental illness. The goal of this guide is to adulthood can be especially to review the literature on treating substance misuse and substance use challenging for young people who disorders in the context of first-episode psychosis, distill the research experience an emerging serious into recommendations for practice, and provide examples of the ways mental illness such as first-episode that these recommendations can be implemented by first-episode psychosis and who have a co- psychosis treatment programs. occurring substance use condition. When first-episode psychosis and FW Evidence-Based Resource Guide substance misuse occur together, Series Overview outcomes tend to be poorer in both Introduction to the series. the short and long term. For young people experiencing 1 Issue Brief Overview of what is happening in the field. This chapter first-episode psychosis, reducing or covers challenges to implementing programs. It provides stopping substance misuse yields descriptions of approaches being used in the field. significant improvements in psychotic symptoms, depressive symptoms, and the young person’s ability to What Research Tells Us 2 lead a meaningful life. Reducing or Current evidence on effectiveness of programs and practices stopping substance use early in the to address first-episode psychosis and co-occurring substance use disorders. experience of psychosis also predicts better long-term outcomes. 3 Examples of Effective Coordinated Coordinated Specialty Care (CSC) Specialty Care Program Models is an integrated approach in which Sample of Coordinated Specialty Care program models multi-component services are that use evidence-based practices to address first-episode provided by clinicians with training psychosis and co-occurring substance use disorders. and experience in working with young adults with first-episode psychosis 4 Guidance for Selecting and and their families. This collaborative Implementing Evidence-Based approach respects the autonomy and Practices and Programs expertise of young people as part Practical information to consider when selecting and of the treatment process and allows implementing programs and practices to address first-episode young people and their families to psychosis and co-occurring substance use disorders. feel better, gain hope for the future, and move towards recovery. CSC 5 Resources for Implementation, can support interventions to address Evaluation, and Quality Improvement substance misuse and substance use Guidance and resources for implementing evidence-based disorders that are provided alongside programs and practices, monitoring outcomes, and services for first-episode psychosis. improving quality. First-Episode Psychosis and Co-Occurring Substance Use Disorders Evidence-Based Resource Guide Series Overview 2 CHAPTER 1 ISSUE BRIEF First-Episode Psychosis and Co-Occurring Substance Use Disorders Background Although the specific definition varies across clinical and research settings, first-episode psychosis is In the United States, the transition to adulthood begins generally regarded as the early period (up to five years) in the late teenage years and continues through the after the onset of psychotic symptoms.2 In many cases, mid- to late-20s. This process can be stressful for first-episode psychosis impacts young people just at young people, given that this is a time when they are the time when they are preparing for and establishing expected to become more self-sufficient and make autonomy as adults.3 important decisions that can shape their futures. Many live on their own for the first time, pursue educational goals, start their careers, and enter serious Psychosis relationships.1 These challenges can
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