Behavioral Treatment of Drug Abuse in Severe and Persistent Mental Illness (SPMI) Patients

Drug and alcohol abuse by people with severe and persistent mental illness (SPMI) is one of
the most significant problems facing the public mental health system. We have been
conducting a project to develop a multifaceted treatment for substance abuse in dual
disordered patients (Behavioral Treatment for Substance Abuse in Schizophrenia; BTSAS).
Results have shown that the treatment is well-accepted by patients and has a significant
effect on drug use. While BTSAS has been effective at retaining subjects and fostering
reduced drug use, a major problem that occurred was low rates of engagement. The main
purpose of this study is to determine if BTSAS is more effective in reducing drug use than a
supportive control treatment and to determine if adding a case management component
(Critical Time Intervention; CTI) will increase treatment engagement and retention in BTSAS.

Inclusion Criteria:

- a diagnosis of schizophrenia or schizoaffective disorder or a diagnosis of other
severe mental disorder including bipolar disorder, major depression, or severe
anxiety disorder (by definition, the patient has worked 25% or less of the past year;
and/or the patient receives payment for mental disability)

- a diagnosis of current dependence for opiates, cocaine, or marijuana

- ability and willingness to attend treatment sessions for 6 months

- ability and willingness to provide consent to participate

- enrolled in mental health care

Exclusion Criteria:

- documented history of severe neurological disorder or severe head trauma with loss of
consciousness

- severe or profound mental retardation as indicated by chart review

- inability to effectively participate in the baseline assessments due to intoxication
or psychiatric symptoms on two successive appointments

- had a substantial trial in either intervention of the Evaluation of Behavioral
Treatment for Substance Abuse in Schizophrenia protocol (H-20680)

- inability to attend group sessions due to transportation or other logistical problems

- inability to attend scheduled treatment sessions on a regular basis for any reason,
or to appropriately participate in research activities due to behavioral or
psychiatric problems