Motivational Interventions for Drugs & Alcohol misuse in Schizophrenia

What was the MIDAS trial?

The MIDAS Trial was a randomised controlled trial (RCT) 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. A randomised controlled trial means that participants are randomly allocated to different conditions. In this trial, participants were either allocated to a) the psychological therapy or b) treatment as usual. Treatment as usual included all the treatment and support people were currently receiving, for example input from the community mental health team, GP, drug or alcohol services.

Why this area?

Many studies have shown that the rate of substance misuse in schizophrenia or psychosis is high, with estimates for community samples in the range of 20 – 40% (1). These people with “dual diagnosis” often have poorer outcomes for example in relation to increases in depression, hospital admissions, psychotic experiences (this refers to the unusual and often distressing experiences of voice hearing and delusional beliefs), suicide, violence and disturbed behaviour. This means there are heavier costs for the person and services but these problems also affect families and the wider society including social and justice systems.

Although the problems of this group of people has been recognised and prioritised in recent Department of Health policy (2), research on treatment development and effectiveness is very limited. Published approaches to the problem have been conducted mainly in the United States, where elements of mental health and substance misuse services have been integrated (work together). One of the recommendations from the Department of Health Dual Diagnosis policy is to have integrated services in this country. The MIDAS Trial aimed to evaluate a psychological therapy for both substance use problems and schizophrenia or psychosis.

What did the Psychological Intervention involve?

Participants allocated to the therapy group received up to 24 sessions of integrated Motivational Interviewing and Cognitive Behavioural Therapy (MI-CBT) plus their usual care. This was delivered over a 40 week period with 2 booster sessions at weeks 45 and 50. Motivational Interviewing is a psychological therapy which has been shown to be helpful for people to resolve ambivalence about substance use and make changes in their lives. Cognitive Behavioural Therapy is a therapy which has been shown to be helpful for a variety of mental health problems, including psychosis. The intervention focused on increasing participants’ motivation to change their substance use and reduce distressing psychotic experiences. The control group received their usual care. In addition, both groups benefitted from a guide on working with people with dual diagnosis, with medical management and service provision details.

Where and when did recruitment for the trial begin?

The trial took place in four mental health trusts across the North West and one in London. Participants were recruited from October 2004 until April 2007.

Who were the therapists?

There were four therapists covering the four mental health trusts in the North West. They were all qualified therapists who had experience of working with people with a diagnosis of schizophrenia and other mental health problems.

There was also a team of people from the University of Manchester and the Institute of Psychiatry who developed the protocol for the trial and were involved in running it. The Principal Investigator was Professor Christine Barrowclough, along with other grant holders Professors Gill Haddock, Nick Tarrier, Graham Dunn and Shon Lewis, Dr Linda Davies and Dr Jan Moring in Manchester and Professors Til Wykes, Tom Craig and John Strang in London. The Trial Manager was Dr Ruth Beardmore.

Who was included in the trial?

People who were living in the community, meeting DSM IV criteria for a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder and drug or alcohol dependence or abuse, and who were prescribed antipsychotic medication.

If you would like any further information about the Midas Trial please contact:

Prof Christine Barrowclough

Principal Investigator

0161 275 8485

References

1. Lehman, A.F & Dixon, L.B. (1995). Double Jeopardy: Chronic Mental Illness and Substance Use Disorders. Chur, Switerland: Harwood Academic publishers.

2. Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. Department of Health (2002)