Bellack A S, DiClemente C C
University of Maryland School of Medicine, Baltimore 21201, USA.
Psychiatr Serv. 1999 Jan;50(1):75-80. doi: 10.1176/ps.50.1.75.
Although substance abuse has reached epidemic proportions among people with schizophrenia, relatively little is known about the critical elements of effective treatment of substance abuse in this population. The authors discuss common assumptions about treatment of substance abuse and review the features of the transtheoretical model of change, which is based on the view that behavior change is a longitudinal process consisting of several stages. In this model, substance abusers must first be persuaded to reduce substance use and then be engaged in treatment before they can be taught the skills necessary to become and remain abstinent. The authors suggest an adaptation of the model that attempts to minimize the impact of the cognitive and motivational deficits associated with schizophrenia. The six-month treatment protocol contains four modules focusing on social skills and problem solving, education about the causes and dangers of substance use, motivational interviewing and goal setting for decreased substance use, and training in behavioral skills for relapse prevention. In the 90-minute, twice weekly sessions, behavioral rehearsal is emphasized, and complex social repertoires, such as refusing substances, are divided into smaller behavioral elements.
尽管药物滥用在精神分裂症患者中已达到流行程度，但对于该人群中药物滥用有效治疗的关键要素却知之甚少。作者讨论了关于药物滥用治疗的常见假设，并回顾了跨理论改变模型的特点，该模型基于行为改变是一个由几个阶段组成的纵向过程这一观点。在这个模型中，药物滥用者必须首先被说服减少药物使用，然后参与治疗，之后才能被传授保持戒除所需的技能。作者建议对该模型进行调整，以尽量减少与精神分裂症相关的认知和动机缺陷的影响。为期六个月的治疗方案包含四个模块，分别侧重于社交技能和问题解决、关于药物使用的原因和危害的教育、动机访谈以及减少药物使用的目标设定，以及预防复发的行为技能培训。在每周两次、每次90分钟的疗程中，强调行为演练，诸如拒绝药物等复杂的社交行为模式被分解为更小的行为要素。
