P1: VENDER/LMD/GGT P2: GDB/GCR
Psychiatric Quarterly [psaq] PH048-340221 June 12, 2001 9:6 Style ﬁle version Nov. 19th, 1999
Psychiatric Quarterly, Vol. 72, No. 4, 2001
INTEGRATING SERVICES FOR
SCHIZOPHRENIA AND SUBSTANCE ABUSE
David J. Hellerstein, M.D., Richard N. Rosenthal, M.D., and
Christian R. Miner, Ph.D.
Over the past decade, several studies have attempted to determine whether
integrating psychiatric and substance abuse treatment leads to better outcome
for patients with comorbid schizophrenia and substance use disorders. A re-
cent (1999) Cochrane Review (1) analyzed the effectiveness of prospective ran-
domized studies of integrated treatment approaches, and concluded that there
was no clear evidence for superiority of integrated treatment. This paper de-
scribes one such integrated treatment approach, in Beth Israel Medical Center’s
COPAD (Combined Psychiatric and Addictive Disorders) program. We summa-
rize ﬁndings from an initial outcome study and a recent replication study; and
describe clinical and research issues relevant to this population. Our data sug-
gests the beneﬁts of integrated treatment for patients with addictive disorders
and schizophrenia, at least with regard to treatment retention. Clinical issues
for such patients include identiﬁcation of patients at risk, proper assessment
and treatment planning, decision-making about mainstreaming vs. referral to
This paper was previously presented at the 2000 American Psychiatric Association
Annual Meeting, Chicago.
The authors are afﬁliated with the New York State Psychiatric Institute, New York,
New York (Hellerstein), and the Department of Psychiatry, Beth Israel Medical Center,
New York, New York (Hellerstein, Rosenthal, Miner).
Address correspondence to David J. Hellerstein, M.D., New York State Psychi-
atric Institute, Unit 101, 1051 Riverside Drive, New York, NY 10032; e-mail:
2001 Human Sciences Press, Inc.