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不良有关。精神分裂症的特征是一系列的症状以及神经认知和心理社会缺陷，使患者难以参与更高水平的认知过程或持续的、自我定向的 通常要求减少饮酒的行为。需要的是一种全面的方法，解决这些多重障碍患者给治疗环境带来的许多问题。 这项申请是对PA-02-067《酒精滥用/精神疾病依赖患者的治疗》的响应。该项目的目的是开发和试点测试一种多方面的行为干预措施，用于治疗患有酒精使用障碍的精神分裂症患者，该干预措施将纳入已被发现有效减少饮酒的策略，但根据这一人群的需求进行量身定制。干预措施将包括几个部分，包括：(1)治疗前动机访谈，以增加参与度和积极性；(2)每节课的经济应急和短期目标设定；(3)社交技能和戒酒技能培训；(4)教育和应对技能培训，以应对抑郁、压力和其他形式的负面情绪；(5)复发预防培训；(6)病例管理，旨在与参与者所在环境中的社会支持建立网络联系，并将患者与社区活动和社会网络联系起来，以创造一个强化的、不饮酒的环境。我们建议为干预措施的每个组成部分开发初步培训材料和手册，对10-12名患者实施先导试验，根据先导研究的结果修改材料，然后对60名患者进行仔细监测的先导试验，将处于实验条件的患者与对照患者进行比较 条件。然后，我们将根据这次初步试验的结果修改材料、节目内容和程序。此外，我们将制定治疗师的依从性和能力测量标准，并收集初步数据，以检验治疗师是否能够学习以可靠和称职的方式实施干预。最后，我们将检查应对技能、神经心理变量和改变饮酒动机之间的关系，并评估应对和动机工具在精神分裂症人群中的使用。

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.