Relapse Among Severely Mentally Ill Alcohol Abusers

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The long-term goal of this proposed research is to develop effective methods for reducing posttreatment alcohol involvement among severely mentally ill (SMI) alcohol-abusing individuals. The specific aims of this research proposal are to test specific hypotheses summarized in a conceptual path model: 1. To examine the direct and indirect effects of psychiatric symptomatology on posttreatment alcohol involvement in schizophrenic individuals. Alcohol involvement outcome will be assessed by several variables including relapse to alcohol use, percent days abstinent, drinks per drinking day, and negative consequences due to alcohol use. It is anticipated that psychiatric symptoms will have both a direct influence on posttreatment alcohol involvement and an indirect effect through the dual-diagnosis treatment and coping skills factors. 2. To examine the direct and indirect effects of alcohol and other substance use problems on posttreatment alcohol involvement. It is predicted that alcohol and other substance use problems will have both a direct influence on alcohol involvement outcomes and an indirect effect through the dual- diagnosis treatment and coping skills factors. 3. To examine the direct and indirect effects of dual-diagnosis treatment on posttreatment alcohol involvement outcomes. It is predicted that dual-diagnosis treatment will have a direct influence on alcohol involvement outcomes and also an indirect effect through the coping skills factor. 4. To examine the direct influence of general and alcohol- specific coping skills on posttreatment alcohol involvement outcomes. It is predicted that poorer coping skills will lead to worse alcohol involvement outcomes. 5. To conduct exploratory analyses examining the moderating effects of gender, ethnic background, antipsychotic medications, and alcohol medications on the association between predictor variables derived from our mediational path model and alcohol involvement outcomes. A longitudinal design will be used to assess multiple measures of key constructs at treatment entry, and every two months thereafter for a period of six months. Key constructs include background characteristics, psychiatric symptomatology, alcohol and other substance use problems, treatment, coping skills, and alcohol involvement outcomes. Importantly, the results of this study will be used to gain an understanding of factors leading to posttreatment alcohol involvement among SMI individuals.