Family Therapy for Schizophrenia: Co-Occurring Psychotic and Substance Use Disorders Jennifer D. Gottlieb, 1 Kim T. Mueser, 1 and Shirley M. Glynn 2 1 Boston University 2 University of California, Los Angeles, CA People with schizophrenia have a high prevalence of co-occurring substance use disorders, which is related to a worse course of psychiatric illness, more frequent relapses, and increased depression and suicide, compared with those with schizophrenia alone. The Family Intervention for Dual Diagnosis (FIDD) program, which includes psychoeducation and goal setting and focuses on building communi- cation and problem-solving skills within the family, can aid in decreasing the stress related to having a close relationship with someone with a dual disorder. Here, the case of a young man with psychosis and marijuana dependence is examined. This article describes how the FIDD intervention helped him with his problematic substance use, as well as to build skills within his relationship for increased empathy and reduced interpersonal stress. C  2012 Wiley Periodicals, Inc. J. Clin. Psychol: In Session 68:490–501, 2012. Keywords: schizophrenia; psychosis; substance use disorders; serious mental illness; dual disorders; family therapy; behavioral family therapy Schizophrenia is a severe mental illness characterized by psychosis, apathy, social withdrawal, and cognitive impairment. With the development and validation of a growing range of evidence- based treatments for schizophrenia, the previously held notion that the disorder is intractable and untreatable has been debunked. Nevertheless, schizophrenia continues to be one of the most disabling psychiatric disorders, and the World Health Organization has ranked it as 1 of the top 10 leading causes of disability worldwide. People with schizophrenia, as well as other severe mental illnesses (SMI) such as bipolar disorder and treatment-refractory major depression, have a high prevalence of co-occurring substance use disorders (or dual disorders). The rates of lifetime substance abuse of about 50% are much higher than the lifetime prevalence of substance use disorders in the general population (about 15%). Clients with dual disorders have a worse course of psychiatric illness than persons with SMI alone, including more frequent relapses and rehospitalizations, homelessness, poor health, legal problems, and increased depression, hopelessness, and suicide (Drake, O’Neal, & Wallach, 2008). Over the past two decades a growing consensus has emerged that traditional approaches to treating dual disorders, such as having separate clinicians treat each disorder or treating the so- called primary disorder first followed by treating the so-called secondary disorder, are ineffective. To replace these outdated approaches, integrated treatments have been developed that target the treatment of both disorders at the same time, by the same clinician. Most integrated treatment programs have focused on group or individual interventions (Barrowclough et al., 2010), or their combination. Although progress has been made in integrated treatment, the results from controlled studies are inconsistent, and improvements are often modest at best, suggesting a need to improve their effectiveness. This research was supported by Grant No. MH62629 from the National Institute of Mental Health National Institute on Drug Abuse. This paper is subject to the National Institutes of Health Public Access Policy. The authors appreciate the following persons for their contributions to this study: Cori Cather, Lindy Fox, Roberto Zarate, Haiyi Xie, Greg McHugo, Robin E. Clark, Rosemarie Wolfe, and Karen Sullivan. Please address correspondence to: Jennifer Gottlieb, Center for Psychiatric Rehabilitation, Boston Univer- sity, 940 Commonwealth Ave. West, Boston, MA 02215; e-mail: jgott@bu.edu JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 68(5), 490–501 (2012) C  2012 Wiley Periodicals, Inc. Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.21852