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

Study Overview
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Brief Summary
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The main purpose of this study is to determine if the multifaceted treatment for substance abuse in dual disordered patients is more effective in reducing drug use than a supportive control treatment. The researchers will also determine if adding a case management component (Critical Time Intervention; CTI) to the intervention will increase treatment engagement and retention.

Detailed Description
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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.

Official Title
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Behavioral Treatment of Drug Abuse in SPMI Patients

Conditions
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Schizophrenia, Mood Disorders, Substance Dependence

Intervention / Treatment
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* Behavioral: Behavioral Treatment for Substance Abuse in SPMI (BTSAS)
* Behavioral: Supportive Treatment in Addiction Recovery (STAR)
* Behavioral: Critical Time Intervention (CTI)


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Behavioral Treatment for Substance Abuse in SPMI (BTSAS) | Behavioral: Behavioral Treatment for Substance Abuse in SPMI (BTSAS)<br>* Multifaceted treatment for substance abuse in dual disordered patients which contains 6 components: 1) a urinalysis contingency to enhance motivation to change and increase the salience of goals; 2) structured goal setting to identify realistic, short term goals for decreased substance use; 3) motivational interviewing to enhance motivation to reduce use; 4) social skills and drug refusal skills to enable development of relationships with people who do not use drugs, and to provide success experiences that can increase self-efficacy for change; 5) education about the reasons for substance use and the particular dangers of substance use for people with SPMI; and 6) relapse prevention training that focuses on behavioral skills for coping with urges and dealing with high risk situations and lapses. BTSAS is specifically structured to reduce the load on memory and attention, and minimize demands on higher level cognitive processes.<br>|
| Experimental: 2<br>Behavioral Treatment for Substance Abuse in SPMI (BTSAS) + Critical Time Intervention (CTI) | Behavioral: Behavioral Treatment for Substance Abuse in SPMI (BTSAS)<br>* Multifaceted treatment for substance abuse in dual disordered patients which contains 6 components: 1) a urinalysis contingency to enhance motivation to change and increase the salience of goals; 2) structured goal setting to identify realistic, short term goals for decreased substance use; 3) motivational interviewing to enhance motivation to reduce use; 4) social skills and drug refusal skills to enable development of relationships with people who do not use drugs, and to provide success experiences that can increase self-efficacy for change; 5) education about the reasons for substance use and the particular dangers of substance use for people with SPMI; and 6) relapse prevention training that focuses on behavioral skills for coping with urges and dealing with high risk situations and lapses. BTSAS is specifically structured to reduce the load on memory and attention, and minimize demands on higher level cognitive processes.<br>Behavioral: Critical Time Intervention (CTI)<br>* Case management component<br>|
| Active Comparator: 3<br>Supportive Treatment in Addiction Recovery (STAR) | Behavioral: Supportive Treatment in Addiction Recovery (STAR)<br>* Manualized substance abuse treatment as usual<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Urinalysis |  | Baseline, 2 and 4 months, post and 6-month follow-up, and at each treatment session | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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treatment, dual diagnosis