Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For patients with substance use disorders, particularly those with coexisting severe mental illness (psychosis), the referral pathway to specialist addiction services typically involves initial assessment by secondary care mental health services.
- Referral from Primary Care: Adults and young people with psychosis or suspected psychosis, including those with suspected coexisting substance misuse, should be referred to secondary care mental health services or CAMHS for assessment and further management NICE CG120. Similarly, those with suspected substance misuse who are suspected of having coexisting psychosis should be referred to secondary care mental health services or CAMHS NICE CG120.
- Involvement of Specialist Substance Misuse Services from Secondary Care: Secondary care mental health services should consider seeking specialist advice and initiating joint working arrangements with specialist substance misuse services for adults and young people with psychosis who are being treated by community mental health teams and are known to be:
- Severely dependent on alcohol NICE CG120.
- Dependent on both alcohol and benzodiazepines NICE CG120.
- Dependent on opioids and/or cocaine or crack cocaine NICE CG120.
- Additional Criteria for Specialist Involvement: Specialist advice and joint working arrangements with specialist substance misuse services should also be considered if the person's substance misuse is difficult to control, and/or leads to significant impairment of functioning, family breakdown, or significant social disruption such as homelessness NICE CG120.
- Planned Detoxification: If a person with psychosis and coexisting substance misuse requires planned detoxification from either drugs or alcohol, this should take place in an inpatient setting NICE CG120.