Many schizophrenics abuse drugs and alcohol creating special problems for clinicians, social service agencies and health care systems. These problems include diagnostic uncertainty, poor treatment adherence, frequent hospitalizations, high rates of homelessness and lack of integrated substance abuse and mental health treatment programs. One of the most important obstacles to treating this population is that schizophrenics do not tolerate or are not helped by standard treatments for substance abuse. This project will develop and pilot test a highly structured, behaviorally based treatment protocol (or module) specifically designed teach drug relapse prevention skills to chronic schizophrenics. The module will be based on behavioral drug relapse prevention strategies originally developed for non-mentally ill substance abusers. These strategies will be adapted for schizophrenics by using a skills training method originally developed to teach social and independent living skills to schizophrenics. This phase one project will be carried out in two stages. Both stages will involve patients being treated in a comprehensive Dual Diagnosis Treatment Program at the West Los Angeles VA Medical Center. All subjects will meet DSM-III-R criteria for schizophrenia and for alcohol, cocaine, marijuana or opiate dependence. In stage one, 40 subjects will participate in testing of the treatment components to ensure that the techniques are feasible for clinicians to conduct, understandable to patients, and user friendly. The subject's ability to comprehend and relate the module contents to personal experiences will be measured. In stage two, 36 subjects will participate in an uncontrolled clinical trial of the module to evaluate its efficacy and determine whether Phase Two controlled trials are warranted. Various assessments (including urine toxicology) will be obtained at entry, and during baseline, training and three month follow up. Analyses will determine the extent to which patients acquire, maintain and use drug relapse prevention skills and the relationship between module content mastery and clinical outcomes.
| Shaner, Andrew; Eckman, Thad; Roberts, Lisa J et al. (2003) Feasibility of a skills training approach to reduce substance dependence among individuals with schizophrenia. Psychiatr Serv 54:1287-9 |
