Substance abuse by schizophrenia patients is one of the most pressing problems facing the mental health system. The lifetime prevalence rate of substance abuse in schizophrenia is close to 50%, and estimates of current abuse range from 20-65%. Excessive substance use by schizophrenics increases the risk of symptom exacerbation and relapse, decreases compliance with treatment, serves as a significant source of conflict in families, and has a pernicious effect on neurological and cognitive functioning. Substance abusing schizophrenia patients are not adequately served by either traditional substance abuse programs or by purely psychiatric programs. There is an urgent need for empirically based programs that integrate essential elements of both psychiatric and substance abuse treatment. The purpose of this project is to conduct a Phase I project to develop and pilot test a multifaceted behavioral therapy to reduce substance use in schizophrenia patIents. The therapy will contain a number of elements, including: 1) social skills and problem solving training, 2) coping skills for managing stress and residual psychotic symptoms that contribute to substance use, 3) education about substance abuse coupled with goal setting; and 4) behavioral (social learning) techniques to decrease substance use and teach relapse prevention skills. Each component of the therapy program will be first be tested in preliminary clinical trials on groups of 6-8 dually diagnosed schizophrenia patients. The procedures will be modified as needed, and a carefully monitored pilot trial of the entire package will then be conducted on 32 patients. The final version will be manualized to allow replication in subsequent studies.
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