Psychosis with substance misuse in over 14s: assessment and management

National Institute for Health and Care Excellence

Key priorities for implementation

Working with adults and young people with psychosis and coexisting substance misuse

  • When working with adults and young people with known or suspected psychosis and coexisting substance misuse, take time to engage the person from the start, and build a respectful, trusting, non-judgemental relationship in an atmosphere of hope and optimism. Be direct in your communications, use a flexible and motivational approach, and take into account that:
    • stigma and discrimination are associated with both psychosis and substance misuse
    • some people will try to conceal either one or both of their conditions
    • many people with psychosis and coexisting substance misuse fear being detained or imprisoned, being given psychiatric medication forcibly or having their children taken into care, and some fear that they may be ‘mad’

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