Schizophrenia alcohol tends to be the most common

Schizophrenia is a long-term and severe psychiatric disorder
which is characterised by a range of psychological symptoms (Drake and Mueser,
2002). Symptoms can present as ‘positive’ such as hallucinations, persistent
delusions, disorganised behaviour, disorganised speech or ‘negative’ symptoms
such as avolition (decrease in motivation), loss of pleasure in usual
activities and social withdrawal (Drake and Mueser, 2002).


Schizophrenia is often complicated by the addition of
comorbid disorders such as substance abuse and medical illnesses (Winklbaur et al., 2006). The substance abuse comorbidity
in Schizophrenia in particular is seen as an attempt from patients, to self-medicate
and alleviate the psychological symptoms of their disorder or side effects from
medication (Chambers et al., 2001).

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Substance use disorder (SUD) is the condition whereby the use
of one or more substances results in a clinical impairment in mental or
physical health or leads to distress (Kavanagh et al., 2002; Winklbaur et al.,
2006). The term substance can refer to any physical material; however in this
case substance is in reference to psychoactive drugs (Winklbaur et al., 2006). SUDs are the most
clinically significant and frequent comorbidities in the UK population, and
alcohol tends to be the most common substance involved (Kavanagh et al., 2002). This is made more likely
due to the widespread abuse of alcohol (amongst those with schizophrenia along
with the general population), the fact it is legal in most populations and its availability
(Drake and Mueser, 2002).


Why do those with Schizophrenia develop SUDs? People are in
all likelihood to abuse alcohol and other substances for similar reasons if not
the same as many others in society, though several factors have been taken into
account such as biological, psychological, and socio-environmental factors
which have been have been theorised to contribute to the high rates of SUDs in
most populations (Kavanagh et al.,
2002; Drake and Mueser, 2002; Bridgman et
al., 2013). Seeing as there are so many factors to consider, how can a
health professional effectively treat a person with a dual diagnosis of Schizophrenia
and SUD?


Individuals who receive a dual diagnosis of Schizophrenia and
SUD have often come to face challenges related to their treatment, with many
health professionals tending to focus primarily on treating either the SUD or
the mental health condition (Bridgman et al.,
2013). As a result there is a lack of integration in psychiatric and SUD
treatment for dual diagnosis patients, leading to poor prognosis derived from
the non-integrated treatment (Bridgman et
al., 2013). Several articles suggest this could be down to the aggravation
of psychological symptoms after the use of substances and/or the appearance of
the mental health condition as a vulnerability leading towards substance abuse  (Bridgman et
al., 2013; Drake and Mueser, 2002; Kavanagh et al., 2002; Winklbaur et al., 2006; Chambers et al., 2001). This implies it is vital
for health professionals to understand the factors which influence the mental
health condition and substance abuse (e.g. the duration and onset of substance
abuse and mental health condition) and how these factors interact to influence
prognosis (Bridgman et al., 2013).


For effective management to occur, an integrated approach
would need to be used in order to meet the needs of each disorder (Farrar et al., 2001). This is where the
integrated model comes into place.


Integrated care, also known by other names
such as “collaborative care” or “co-ordinated care”, combines mental health
care and primary health care. This is an important model of care, as it
encourages a collaborative approach by blending the expertise from different
areas such as primary care clinicians, substance use and mental health
(including feedback from patients and their caregivers) to provide general
medical care and mental health care in one setting (Farrar et al.,
2001; National Institute for Mental Health, 2017).


This coordination of care enables services
to address the patient as a whole for both mental and physical health problems
and essentially avoid neglecting either. By combining services and expertise
services can reduce costs, improve the quality of care and hopefully provide
effective help for individuals in a timely manner (Farrar et al.,
2001; National Institute for Mental Health, 2017). Mental illnesses that go untreated can
have severe consequences if neglected and not given medical treatment by a primary
care provider earlier; those neglected can often decrease their life span by up
to 13-30 years (National Institute for Mental Health, 2017).