Table 1. Reviews of Treatment for Comorbid Disorders.
| Author(s)/Year | Comorbidities | Psychotherapies/Pharmacotherapies | Major Findings |
|---|---|---|---|
| Aase et al./2008 | Unspecified Dual Diagnoses | Yes / No | 12-Step participation was associated with abstinence in 80% of reports w/abstinence as an outcome; 43% of studies found 12-Step improved psychological functioning |
| Baker, et al./2010 | Can/Psychotic/Depressive | Yes / Yes | Longer, more intensive treatments may be necessary for can users with chronic mental disorders, compared to brief interventions (<10 sessions) |
| Brady & Verduin/2005 | Sub Use Dis/Mood, Anx | No / Yes | Meds for mood, anx disorders may also help sub use; meds for patients with comorbidity should be chosen on safety, toxicity, abuse potential |
| Cornelius et al./2003 | Alc/Dep/Anx | No / Yes | SSRIs and tricyclic antidepressants may be effective for both disorders; buspirone may be helpful for alc/anx |
| Drake et al./2008 | Sub Use/Severe Mental Dis | Yes / No | CM, group, residential treatments are beneficial for sub use; case management, legal Intervention are positive for stability in community and treatment retention |
| Fatseas et al./2010 | Opioids/Anx | Yes / Yes | Most effective meds are tricyclics; SSRIs may work (try SSRIs first for reduced side effects); avoid benzos; best treatment Is integrated pharmacotherapy and psychotherapy |
| Green et al./2002 | Alc,Others/Schizophrenia | No / Yes | Clozapine superior to other meds, abstinence is critical |
| Hesse/2009 | Sub Use/Anx, Dep | Yes / No | Integrated psychotherapy alone is not effective in comorbid sub use and dep/anx; new approaches needed |
| Hjorthoj et al./2009 | Can/Schizophrenia | Yes / No | CM effective against can use; MI and CBT effective against drug use in combined analyses but not against can alone; should use separate analyses for different drugs |
| Levin & Hennessy/2004 | Sub Abuse/Bip | Yes / Yes | Integrated treatments of group therapy should be used w/med specific for sub abuse, if available; disulfiram is promising for bip/alc patients |
| Lubman et al./2010 | Substances/Schizophrenia | Yes / Yes | Clozapine and naltrexone are effective; integrated treatment is best psychosocial approach |
| Lybrand et al./2009 | Alc., Can, Coc/Schizophrenia | No / Yes | Atypical antipsychotics are effective; clozapine is superior |
| Maremmani et al./2010 | Drugs of Abuse/Mood Disorders | No / Yes | Mood stabilizers may be better choices than antidepressants for drug/mood comorbidity; valproate is best |
| McCarthy & Petrakis/2010 | Alc/PTSD | Yes / Yes | Effective treatment includes integrated evidence-based psychotherapies (e.g., Seeking Safety) and medication (SSRI, topiramate) |
| Negrete/2003 | Can, Opioids/Psychosis | Yes / Yes | Need for intense, integrated treatment; atypical antipsychotics superior to 1st generation antipsychotics |
| Nunes & Levin/2004 | Alc, Other Drugs/Dep | No / Yes | Antidepressants have a modest effect on comorbid dep-sub use disorders; sub use should be treated with substance specific pharmacotherapies, if available |
| Pettinati/2004 | Alc/Dep | No / Yes | Antidepressants have little impact on alc use; treat alc abuse with specific medication |
| Quello et al./2005 | Sub Use D/O/Dep, Bipolar | Yes / Yes | Lithium + valproate may be most effective med treatment; critical elements of manual guided psychotherapy should be used |
| San et al./2007 | Alc,Coc,Can/Schiz | No / Yes | Clozapine effective against alc and can; olanzapine and risperidone appear effective against coc; more research needed |
| Schafer & Najavits/2007 | Sub Abuse/PTSD | Yes / Yes | Five structured psychotherapies reviewed, Seeking Safety has most support; both naltrexone and disulfiram should be considered for alc abuse |
| Smelson et al./2008 | Alc,Opioids/Schizophrenia | Yes / Yes | Atypical antipsychotics superior, enhance retention in treatment; clinicians should be familiar with evidence-based approaches and be flexible in treatment planning |
| Tiet & Mausbach/2007 | Sub Use Disorders/Mental Illness | Yes / Yes | Efficacious treatments for both mental and sub use disorders are effective when combined for dual diagnosis; the efficacy of integrated treatment is unclear |
| Torrens et al./2005 | Alc, Coc, Nic, Opiods/Dep | No / Yes | Antidepressants (buprop/nortrip) effective for nicotine; not clear for others; more research needed |
| Upadhyaya/2007 | Sub Use Dis/ADHD | No / Yes | Stimulants may be abused, include family in treatment planning; use long-acting meds, try non-stimulants first with sub-abusing patients; higher doses of stimulant meds for ADHD may reduce coc use |
Notes: alc=alcohol; can=cannabis; anx=anxiety; buprop=buporprione; dep=depression; dis=disorder; meds=medications; nortrip=nortrityline; coc=cocaine; SSRI=Selective Serotonin Reuptake Inhibitor; CM=contingency management