The Impact of Treatment Orders for Residential Treatment of Comorbid Severe Substance Use Disorders for Youth Suffering from Early Psychosis: a Case Series

Impacts of comorbid severe substance use disorders (SUD) on first-episode psychosis (FEP) patients can, in some cases, be extremely serious (dangerousness, suicidality, homelessness). Traditional treatment approaches for SUD may unfortunately fail or not be acceptable to them. Impacts of mandatory residential SUD treatment (RT) are sometimes integrated to community treatment orders (CTO) but have not been studied. This is a retrospective longitudinal study by medical file review of 16 FEP patients with serious consequences of severe comorbid FEP and substance use disorders, who attended mandatory RT prescribed within a CTO. Outcomes were compared before and after mandatory RT. The mean follow-up was 4.4 years (2.3 years before RT, 2.2 years thereafter). After the mandatory RT, increased likelihood of alcohol, cannabis, amphetamines and cocaine abstinence was observed. The number of patients needing hospitalizations, presenting dangerous behaviours or employment and housing instability, decreased. Further research must be conducted to gain a more in-depth understanding of the clinical and ethical impacts of this legal approach, as well as potential pitfalls.