Substance abuse in psychiatric emergencies: the family crisis and its developments

Background. The objective of the present research is to evaluate the impact that substance abuse has on those with schizophrenia and the efficacy of systemic family therapy in decreasing the relapse rate. Methods. Forty subjects suffering from schizophrenia or correlated diseases were recruited at the Emergency Psychiatric Unit of Milan University; 19 patients (45%) have a codiagnosis of substance abuse or substance dependence. In this group, six patients (33%) underwent systemic family therapy within the intervention and have been associated with routine psychiatric treatment. Results. In 34 patients with schizophrenia diagnosis who underwent routine psychiatric treatment, the results showed that subjects who were substance abusers at the moment of recruitment (Ist group) had a significantly increased relapse rate compared with that of schizophrenic patients who did not have a substance abuse codiagnosis (2nd group), at both 12 (p = 0.04) and 24 months (p; 0.01) follow-up. The 13 substance abuser patients were compared with a group of six patients, who underwent systemic family therapy. The relapse rate in the 2nd group was lower both at 12 and 24 months (p = 0.01). Conclusion. The contemporary presence of schizophrenia diagnosis and substance abuse seems to worsen the prognosis; systemic Family therapy intervention started in the "emergency" moments appears to significantly reduce the relapse rate and increase the adherence of interventions in the need for dependency management.