Relapse Among Severely Mentally Ill Alcohol Abusers

这项拟议研究的长期目标是开发有效的方法来减少严重精神疾病(SMI)酗酒者治疗后的酒精参与。本研究方案的具体目的是检验概念性路径模型中总结的具体假设：1.检验精神症状学对精神分裂症患者治疗后酒精卷入的直接和间接影响。酒精参与的结果将通过几个变量进行评估，包括再次饮酒、戒酒天数百分比、每天饮酒量以及饮酒造成的负面后果。预计精神病症状将通过双重诊断治疗和应对技能因素对治疗后的酗酒行为产生直接影响和间接影响。2.考察酒精和其他物质使用问题对治疗后酒精卷入的直接和间接影响。据预测，酒精和其他物质使用问题既会对酒精依赖的结果产生直接影响，也会通过双重诊断治疗和应对技能因素产生间接影响。3.探讨双重诊断治疗对酒精依赖治疗后结局的直接和间接影响。据预测，双重诊断治疗将对酒精依赖结局产生直接影响，并通过应对技能因素产生间接影响。4.考察一般应对技能和特定酒精应对技能对酒精依赖治疗后结局的直接影响。据预测，较差的应对技能将导致更糟糕的酗酒结果。5.进行探索性分析，检验性别、种族背景、抗精神病药物和酒精药物对我们的中介路径模型得出的预测变量与酒精参与结果之间的关联的调节作用。在治疗开始时，将使用纵向设计来评估关键结构的多个测量，此后每两个月评估一次，为期六个月。关键结构包括背景特征、精神症状、酒精和其他物质使用问题、治疗、应对技能和酒精参与结果。重要的是，这项研究的结果将被用来了解导致SMI患者治疗后酒精参与的因素。

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.