An evaluation of motivational (MI) plus cognitive behaviour therapy (CBT) for schizophrenia and substance misuse.

Lead Research Organisation: University of Manchester
Department Name: Medical and Human Sciences


We are evaluating a psychological therapy for people with schizophrenia or psychosis who also use drugs and/or alcohol.

Unfortunately, using substances when a person has severe mental health problems can have very negative and long term consequences. People tend to relapse and need hospitalisation more often and can become very disturbed. Despite the problems, services are unclear of the best way to help such patients. There have, however, been some promising recent studies of possible treatments.

We are comparing a new psychological approach with the treatment patients currently receive. This approach tries to increase patients’ motivation to cut down or stop using drugs and alcohol by helping them to weigh up the costs and benefits of using. It also offers help -cognitive behaviour therapy- in how best to make changes. This may include coping with the most unpleasant symptoms the person experiences, these may be hearing voices or depression or paranoid fears. Sometimes people use drugs or alcohol to help them deal with these problems.

This research has the potential to influence mental health clinical practice in a very substantial way. The treatment approach might be used both nationally and internationally if found to be successful. There may also be considerable cost savings given that the illness complications associated with continued substance use in schizophrenia are expensive.

Technical Summary

Substance misuse in schizophrenia is high and this ?dual diagnosis? is associated with many poor outcomes including increased hospitalisations. Despite these problems, the evidence base for specialist interventions with dually diagnosed clients is limited. The proposed study is a two centre multi-site evaluation of an individual patient care intervention for dually diagnosed patients. Patients with schizophrenia and a drug or alcohol abuse or dependence problem will be recruited as inpatients or outpatients and following stratification on factors believed to be predictive of treatment participation or outcome will be randomly allocated to receive either Motivational Intervention and Cognitive Behaviour Therapy (MI plus CBT) treatment in addition to standard psychiatric care or standard care alone. The intervention will aim to match the focus of treatment to the patient?s motivation to change substance use and to the relationship between the substance use and the psychosis in a formulation driven approach. The trial allows for flexibility in the number and duration of sessions taken up by clients with all patients offered up to 24 sessions of MI plus CBT over 40 weeks with 2 booster sessions at 45 and 50 weeks (12 months treatment phase in total). Blind and independent assessments will be conducted at baseline, end of one year treatment period and at two year follow up.The primary hypothesis to be tested is that the intervention will result in a significant reduction in hospitalisations. Secondary outcomes are changes in substance use, symptomatology and number of relapses. A health economic study will also be conducted to assess the wider costs and benefits of the intervention.


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Description Citation in New Horizons policy document for psychosis and substance misuse
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact Regarding the MIDAS trial, the New Horizons document states: "MIDAS (Motivational Interventions for Drug and Alcohol misuse in Schizophrenia) is a large, randomised control trial investigating the efficacy of a psychological intervention at reducing relapse and substance misuse in people with a diagnosis of schizophrenia or psychosis with drug or alcohol problems. The trial has already been successful in recruiting and retaining sufficient individuals. The learning from this trial will be made available to inform policy."
Description NHS Trust Annual General Meeting - poster 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Primary Audience Health professionals
Results and Impact A poster summarising preliminary trial results was displayed at the NHS Trust Annual General Meeting. This was an open meeting, attended by clinicians, service users and carers. Interested individuals were provided with summary leaflets which also referred them to the Trial website for further details.

Year(s) Of Engagement Activity 2010
Description Trial Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Participants in your research and patient groups
Results and Impact Participants were updated on the progress of the trial via newsletters. They were also encouraged to send their own contributions to the newsletter, such as creative writing pieces. The newsletter was also sent to referring NHS services for their information.

The intention was to enable the participants to feel more involved in the trial and to encourage them to continue participating. Providing participants and NHS staff with regular updates may have encouraged recruitment and retention of trial participants.
Year(s) Of Engagement Activity 2006,2007,2008,2009