Treatment of Alcohol Use Disorders in Schizophrenia

精神分裂症患者的酒精使用障碍是一个严重的公共卫生问题，与治疗依从性差，复发率增加，暴力水平增加以及健康和生活功能差有关。精神分裂症的特点是一系列的症状和神经认知和心理社会缺陷，使患者难以从事更高层次的认知过程或持续的，自我导向的 通常需要减少饮酒的行为。我们需要的是一个全面的方法，解决这些多重残疾患者带来的治疗环境的许多问题。 本申请是对PA-02-067，酒精滥用/酒精依赖伴精神病合并症患者的治疗的回应。该项目的目的是开发和试点测试一种多方面的行为干预，用于治疗患有酒精使用障碍的精神分裂症患者，其中将纳入已发现有效减少饮酒的策略，但将其调整为满足这一人群的需求。干预措施将包括几个组成部分，包括：（1）治疗前动机访谈，以增加参与和动机;（2）每次治疗的财务应急和短期目标设定;（3）社交技能和拒绝饮酒技能培训;（4）管理抑郁、压力和其他形式负面影响的教育和应对技能培训;（5）预防复发培训;（6）病例管理，旨在与参与者环境中的社会支持建立网络，并将患者与社区中的活动和社交网络联系起来，以创造一个强化的非饮酒环境。我们建议为干预的每个组成部分编写初步培训材料和手册，对10-12名患者进行预试验，根据预试验研究的结果修改材料，然后对60名患者进行仔细监测的预试验，将实验条件下的患者与对照条件下的患者进行比较 条件然后，我们将根据初步试验的结果修改材料和程序内容和程序。此外，我们将制定治疗师依从性和能力的措施，并收集初步数据，检查治疗师是否能够学会以可靠和称职的方式管理干预。最后，我们将研究应对技能，神经心理学变量和改变饮酒动机之间的关系，并评估精神分裂症人群中应对和激励工具的使用。

Alcohol use disorders in people with schizophrenia is a serious public health problem that is associated with poor treatment compliance, increased rates of relapse, increased levels of violence, and poor health and life functioning. Schizophrenia is marked by a constellation of symptoms and neurocognitive and psychosocial deficits that make it difficult for patients to engage in the higher level cognitive processes or the sustained, selfdirected behaviors generally required to reduce drinking. What is needed is a comprehensive approach that addresses the many problems that these multiply-handicapped patients bring to the treatment setting. This application is in response to PA-02-067, Treatment of Alcohol Abuse/Dependent Patients with Psychiatric Comorbidity. The purpose of this project is to develop and pilot test a multifaceted behavioral intervention for treating schizophrenia patients with alcohol use disorders that will incorporate strategies that have been found to be effective in reducing drinking, but tailor them to meet the needs of this population. The intervention will contain several components, including: (1) pre-treatment motivational interviewing to increase engagement and motivation; (2) financial contingency and short-term goal setting at each session; (3) social skills and alcohol refusal skills training; (4) education and coping skills training for managing depression, stress and other forms of negative affect; (5) relapse prevention training; (6) case management aimed at networking with social supports in the participant's environment and linking patients with activities and social networks in the community in order to create a reinforcing, nondrinking environment. We propose to develop preliminary training materials and manuals for each component of the intervention, to implement a pre-pilot trial with 10-12 patients, revise the materials based on findings from the pre-pilot study, and then conduct a carefully monitored pilot trial on 60 patients, comparing patients in the experimental condition to those in a comparison condition. We will then modify materials and program content and procedures based on the results of this initial trial. In addition, we will develop therapist adherence and competence measures and collect preliminary data examining whether therapists can learn to administer the intervention in a reliable and competent manner. Finally, we will examine the relationships among coping skills, neuropsychological variables, and motivation to change alcohol use, and evaluate the use of coping and motivational instruments in a schizophrenia population.