Treating Co-Occurring Mental Illness and Substance Use: What the Evidence Shows
Hunt GE, Siegfried N, Morley K, Brooke-Sumner C, Cleary M · Cochrane Database of Systematic Reviews
A Cochrane review of randomized trials of psychosocial treatments for people with severe mental illness and substance misuse: what it does and does not show.
- A Cochrane review of 41 randomized trials (4,024 people with severe mental illness and substance misuse) found no clear evidence that integrated care models improved retention, substance use, functioning, or life satisfaction compared with standard care.
- Most of the evidence was rated low or very low quality, because trials were small and methods were often poorly reported.
- No single psychosocial approach (CBT, motivational interviewing, contingency management, or integrated care) was clearly better than standard care across outcomes.
- SAMHSA recommends screening for both conditions and coordinating their treatment.
Why it matters
In 2025, about one in three U.S. adults with a mental illness also had a substance use disorder (NSDUH). Coordinated care is the recommended standard, but families should not be told that any one model is proven to work better.
Limitations
The review covers severe mental illness (mainly psychotic disorders); results may not apply to depression or anxiety with substance use.
Original source
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