(Applicant?s Abstract) The proposed randomized clinical trial is to test the effects of augmenting case managers? usual treatment of seriously mentally ill drug abusing patients by providing a distinctive intervention for drug abuse. The treatment, Behavioral Treatment for Substance Abuse in Schizophrenia--BTSAS (Bellack, Gearon, Everist, Alexander, 1998), is a six month intervention, provided in group format, designed to teach basic skills to facilitate reduction in drug use, to cope with stress, and to heighten awareness of negative consequences of substance abuse including increased risk of exposure to HIV. BTSAS (BT) is a promising, behavioral skills training treatment, developed under a NIDA treatment development grant DA09406 (Bellack) that has the advantage of a comprehensive and explicit manual to guide provision of treatment and training of therapists. The study will extend an established line of inquiry concerning effective treatments for drug-dependent seriously mentally ill adults. It is consistent with the focus of the TRC on treatment for complex drug-abusing patients, in clinical settings that have not typically provided specialized treatment for drug abuse and congruent with the TRC?s orientation towards cognitive behaviorally based interventions. The study will assess the effectiveness of adding BT to case management as usual and will test whether BT: (1) can be successfully exported to clinical case management settings; (2) can effect reduction in drug use and in the practice of AIDS risk behaviors; and (3) is associated with alterations of service utilization patterns that reflect a reduction in crisis treatment episodes and in treatment costs. Furthermore, the study will test whether BT: (4) is associated with improved quality of life; and (5) will have differential effects for participants who are cocaine-dependent. Primary hypotheses concern psychosocial and service utilization outcomes, and BT treatment processes. Secondary hypotheses concern status of cocaine-dependent participants relative to other study participants. This study is enhanced by Dr. Bellack?s consultation and by being integral to the scientific endeavors of the TRC. The collaborative style of the TRC will inform development of a smoking treatment intervention to be piloted in collaboration with Dr. Hall and the development of process measures with Dr. Sorensen to study case management for drug abusers. Core support for hypotheses testing and economic analyses will ensure the methods applied here will be among the most powerful.
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