Clairélaine Ouellet-Plamondon1, Amal Abdel-Baki1; 1CHU Montreal, Canada
Background: Co-occurring substance use disorders (SUD) are very common (about 60%) in first episode psychosis and associated with poor symptomatic and functional outcomes. After 2 years of follow up in early intervention service (EIS), about a third of FEP patients have persistent SUD despite motivational and harm reduction philosophies. Homelessness history, borderline personality and the severity of SUD at baseline have been associated with persistent misuse at 2-year follow up. Methods: Based on SUD trajectories and factors associated with SUD persistence in FEP, we developed and integrated FEP-SUD program within our EIS including evidence-based interventions targeting SUD and its associated factors. Results: We will describe the different components of this ‘à la carte’ program tailored to offer interventions corresponding to each patient characteristics and needs at different time points in their trajectory. Preliminary results and pilot data of different interventions of this program (including pharmacological strategies as well as psychosocial treatments) will be presented. Outreach case management interventions, injectable antipsychotic medication, peer support, supervised housing as well as “housing first” program, manualised individual intervention (including motivational and CBT strategies) as well as group and family systemic psychotherapy and, for the more severe cases, treatment orders for mandatory inpatient therapy for SUD will be described. Conclusions: Treating comorbid SUD with FEP is challenging. However different strategies must be offered early in the course of illness to help modify their trajectory. Although it is an heterogeneous group, personalized addiction treatment plans can be built to improve FEP outcome.
