• Very few randomized controlled trials of psychological interventions for excessive alcohol use in
people with psychotic disorders have been conducted, despite the high prevalence of alcohol use
disorders in this population.
• Clinically meaningful changes in alcohol consumption in people with psychotic disorders have been
observed after single session brief intervention and assessment interview and longer (i.e. 10 sessions)
cognitive behavioral interventions.
• Longer interventions additionally improve domains besides alcohol use, such as functioning and
mental health, which could be useful for people with multiple psychiatric comorbidities or those who
do not respond to brief intervention ⁄ assessment.
Acta Psychiatr Scand 2012: 126: 243–255
All rights reserved
DOI: 10.1111/j.1600-0447.2012.01885.x
_ 2012 John Wiley & Sons A/S
ACTA PSYCHIATRICA
SCANDINAVICA
243
Introduction
Epidemiological studies consistently indicate that
excessive alcohol consumption and alcohol use
disorders (i.e. abuse or dependence) are common
among people with psychotic disorders (1–3).
Clinical studies suggest that between 13% and
43% of people with psychotic disorders have
alcohol use disorders (4–8). Alcohol and other
drug use have been associated with a broad range
of adverse clinical, functional, social, and treatment
outcomes in psychosis (9–14). Excessive
alcohol consumption, internationally defined as
more than two to three standard drinks per day
(15), together with smoking, a high fat diet, and
sedentary behavior are the main behavioral risk
factors for cardiovascular disease, which is the
largest single cause of death among people with
psychotic disorders (16, 17). The high prevalence
of alcohol use disorders among people with
psychotic disorders, as well as the associated
adverse impact on functioning, morbidity, and
mortality, highlights the need for effective
interventions.
While there is an extensive literature reporting
on the efficacy of psychological treatments for
excessive alcohol consumption (18–21), to date few
clinical treatment trials have specifically focussed
on addressing excessive alcohol consumption
among people with psychosis. Furthermore, while
numerous studies and several reviews have investigated
the effectiveness of treatments for substance
use in general among people with psychosis (22),
very few studies have examined outcomes regarding
alcohol specifically. Such a distinction is
necessary as differential treatment effects for alcohol
use compared with other substances have been
reported among people with severe mental illness
(23).