The purpose of this research is to evaluate the effectiveness of adding drug abuse and alcohol treatment services to standard psychiatric treatment of chronically mentally ill state hospital patients with co- occurring alcohol/drug abuse disorders. The experimental design is a classic pre- and post-treatment design: Subjects meeting DSM-III-Revised (1987) criteria for Psychoactive Substance Use Disorder and another Axis I disorder (such as Schizophrenia or Major Affective Disorder) are randomly assigned to one of three treatment conditions (N-240): one, standard inpatient and outpatient treatment (n + 80): two, individualized general social skills training (using modular treatment (n=80 termed the General treatment condition) and three, individualized relapse prevention treatment (using methods developed by Marlatt and associated) targeting stress disorders (n = 80, termed the Specific treatment condition). Both the General and Specific Treatment conditions, designed to be delivered over a six-month period beginning during inpatients treatment and extending into our patient treatment, are administered as an additional resource within the context of existing case management services: therapists are research study personnel supervised by board-certified investigators off this study. Patients/subjects will consist of equal numbers of male and female patients meeting Axis I criteria for chronic mental disorders and co-occurring alcohol/drug abuse disorders: subject will be randomly assigned to study cells into subcategories """"""""high"""""""" and """"""""low"""""""" in past stressful/traumatic events and experiences. The study is designed to answer two questions: one, Does treating substance abuse of the dually-diagnosed patient (i.e., chemically-dependent chronic mental patient) result in improved treatment outcome? and two, Does specific treatment of subject situational characteristics (e.g., high and low in stressful/traumatic background histories: improve treatment outcome? Outcome measurement is based upon multidimensional adjustment assessment obtained at six month intervals, for one year, after establishing baseline adjustment levels. Outcome measures are derived from addiction Severity Indices interviews (e.g., self-reported alcohol and drug use, subjective distress measures, rehospitalizations post-treatment violence and aggressive episodes, functional disability, etc.) and biochemical indices.
