Treating substance abuse among patients with schizophrenia

Although substance abuse has reached epidemic proportions among people with schizophrenia, relatively little is known about the critical elements of e ffective treatment of substance abuse in this population. The authors discu ss common assumptions about treatment of substance abuse and review the fea tures of the transtheoretical model of change, which is based on the view t hat behavior change is a longitudinal process consisting of several stages. In this model, substance abusers must first be persuaded to reduce substan ce use and then be engaged in treatment before they can be taught the skill s necessary to become and remain abstinent. The authors suggest an adaptati on of the model that attempts to minimize the impact of the cognitive and m otivational deficits associated with schizophrenia. The six-month treatment protocol contains four modules focusing on social skills and problem solvi ng, education about the causes and dangers of substance use, motivational i nterviewing and goal setting for decreased substance use, and training in b ehavioral skills for relapse prevention. In the 90-minute, twice weekly ses sions, behavioral rehearsal is emphasized, and complex social repertoires, such as refusing substances, are divided into smaller behavioral elements.