Treatment of Alcohol Use Disorders in Schizophrenia

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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.