Focusing on patients with severe impairments, including mixed and multiple diagnoses, this volume describes how behavior therapy fits into the clinical environment. Psychiatrists, medical clinicians, and residents will appreciate the in-depth coverage of a broad range of difficult issues.

The last few years have seen an increasing awareness among the mental health community to the unique situations of the person suffering simultaneously from mental health disorders and substance abuse addiction. Complementing this rise in attention has been a realization of the unique challenges faced by mental health professionals engaged in the treatment of these clients, and a startling acknowledgement of the gap in the existing literature on the topic. There is currently no available treatment manual that includes specific training on how to treat this difficult population, following guidelines and practical instructions based on treatment practices already employed by the authors. This treatment manual will fill an important gap in the literature by addressing the specific challenges faced by the clinician treating individuals with co-occurring schizophrenia and substance abuse disorders.
The unique strength of the proposed volume is its close adherence to a treatment plan proven successful by empirical research and now being made available for the practicing clinician. The book is designed as a manual for mental health professionals, and follows a program which incorporates various treatment components, from motivational interviewing, urinalysis contingency, and social skills training to education and coping skills, problem solving and relapse prevention, and finally termination. Guidelines are clearly established for these treatment modes, utilizing case examples and fictional situations to allow the reader to profit more directly from the lessons in the text. The book follows a treatment outline that will allow the clinician to pattern a series of therapy sessions after thesuggested timeframe found within the text. Additionally, the format and flow of individual sessions is carefully considered and discussed, allowing the clinician a model from which to base a treatment plan.

In the last decade there has been heightened clinical and investigative activity in the area of family violence. This, of course, is partly attributable to recent surveys showing a high incidence of family violence in the United States. For example, there are indications that nearly 30% of married women in this country are victims of physical abuse by spouses at some point in their marriage. Further, FBI statistics show that approximately 13% of all homicides are husband-wife killings. Moreover, it has been projected that such figures are likely to increase over the next several years. Consistent with these trends, funding of family violence research by both federal and private agencies has increased. Indeed, federal agencies, such as the National Institute of Mental Health and the National Institute of Law Enforcement and Criminal Justice, have provided considerable support for work in this area. In addition, family violence, particu larly wifebattering, child abuse, and sexual abuse of children has been the focus of media attention at the national level, and has generated intensive interest in both lay and profes sional publications. Moreover, there have been several recent governmental hearings and investigations regarding the prevalence of these problems."

Psychotherapy research is undoubtedly one of the most puzzling, diverse, com plex, controversial, and multidimensional areas tackled by clinical psycholo gists, psychiatrists, and psychiatric social workers. The numerous theoretical, methodological, and clinical-research issues dealt with by workers in the field have increased exponentially in the past three decades. To do full justice to the area, monographs in each of the specific subareas would be warranted. In this volume, we, as editors, have endeavored to present the student and interested professional and practitioner with an understanding of the most salient issues and trends confronted by the psychotherapy researcher. In order to accomplish this task, we asked our colleagues, who are experts in their respective areas, to share their current thinking with us and with you, the read ers. Thus, many theoretical viewpoints are represented, with none having a monopoly over the others. This is as it should be, given the data collected by clinical researchers at this time. We have also attempted to capture the excite ment that has permeated the field in the past 30 years or so."

Research on the nature and treatment of schizophrenia has undergone a revival and metamorphosis in the last decade. For a long while, the field had been moribund, weighed down by an unreliable diagnostic system, pessi mism about the possibility of new discoveries, and a dearth of research funds. A number of factors have seemingly coalesced to change this situa tion, with the result that the field is now alive with excitement and optimism. Four factors seem to have played important roles in the resurgence of interest. First, prior to the publication of DSM-III in 1980 there was no reliable diagnostic system for the disorder. Previous definitions were overly general and imprecise. Consequently, the label "schizophrenia" applied to a very heterogeneous group of severely disturhed patients. It was rarely clear whether two investigators had studied comparable samples, making it im possible to determine if (flew findings were generalizahle or if failures to replicate were due to the unreliahility of the results or the fact that the investigators had studied different disorders. DSM-III has not totally re solved this problem, but it has allowed scientists to reliably identify a much more homogeneous group. As a result, it is now possible to integrate the results of different studies, making it much more likely that we can make important advances. The second important factor was the development of new technologies that promised to help uncover the nature and etiology of the disorder."

The correlation between schizophrenia and substance abuse in psychology is recognized as a growing issue, yet it is one that many practitioners are often ill-prepared to address. Behavioral Treatment for Substance Abuse in People with Serious and Persistent Mental Illness addresses the specific challenges faced by the clinician treating individuals with co-occurring schizophrenia and substance abuse disorders. Designed as a treatment manual for mental health professionals, the book incorporates various treatment components, from motivational interviewing and social skills training to education, problem solving, and relapse prevention. The book presents clearly established guidelines for these treatment modes and utilizes both case examples and fictional situations to present a practical, hands-on approach. Readers will profit directly from the lessons in the book, which offers the clinician an invaluable model from which to base a treatment plan.

Throughout the last decade, the field of clinical psychology has expanded dramatically. Clinical psychologists are involved in the treatment and research of a wider range of problems and disorders than they have ever been before. Evidence has been rapidly ac cumulating regarding the role of psychological variables and stress in the etiology and maintenance of a range of medical and psychiatric disorders. New models of psy chotherapy have been developed and refined, and the specific efficacy of psychother apeutic interventions for an increasing number of disorders (or sUbtypes of disorders) has been documented. However, concurrent with research that demonstrates the impact of psychosomatic factors in various disorders and the efficacy of psychological or psychosocial interven tions, dramatic progress has been made with regard to the investigation of biological factors that may mediate certain disorders. That physical factors may underlie many in stances of psychiatric illness has been repeatedly demonstrated. Also, the efficacy of so matic treatments for different disorders, or for subtypes of disorders, has been reported with increasing methodological rigor."

Psychotherapy research is undoubtedly one of the most puzzling, diverse, com plex, controversial, and multidimensional areas tackled by clinical psycholo gists, psychiatrists, and psychiatric social workers. The numerous theoretical, methodological, and clinical-research issues dealt with by workers in the field have increased exponentially in the past three decades. To do full justice to the area, monographs in each of the specific subareas would be warranted. In this volume, we, as editors, have endeavored to present the student and interested professional and practitioner with an understanding of the most salient issues and trends confronted by the psychotherapy researcher. In order to accomplish this task, we asked our colleagues, who are experts in their respective areas, to share their current thinking with us and with you, the read ers. Thus, many theoretical viewpoints are represented, with none having a monopoly over the others. This is as it should be, given the data collected by clinical researchers at this time. We have also attempted to capture the excite ment that has permeated the field in the past 30 years or so."

Focusing on patients with severe impairments, including mixed and multiple diagnoses, this volume describes how behavior therapy fits into the clinical environment. Psychiatrists, medical clinicians, and residents will appreciate the in-depth coverage of a broad range of difficult issues.

Despite the occasional outcries to the contrary, the field of behavior therapy is still growing, and the asymptote has not been reached yet. The umbrella of behavior therapy continues to enlarge and still is able to encompass new theories, new con cepts, new research, new data, and new clinical techniques. Although the number of new behavioral journals now has stabilized, we still see a proliferation of books on the subject. In the past few years, however, we have seen considerable specialization within behavior therapy. No longer is it possible to be a generalist and remain fully abreast of all the relevant developments. Thus, we see behavior therapists who deal with adults, those who deal with children, those whose specialty is hospital psychiatry, and those who see themselves as practitioners of behavioral medicine. Even within a subarea such as behavioral medicine, specialization runs supreme to the extent that there are experts in the specific addictions, adult medical problems, and child medical problems. Given the extent of specialization, there are numerous ways "to skin" the pro verbial "cat." We therefore have chosen to look at the contemporary work in behavior therapy that is being carried out with adults, in part, of course, because of our long-standing interest in this area as teachers, researchers, and clinicians. In so doing, we have chosen to highlight the clinical aspects of the endeavor but not at the expense of the rich research heritage for each of the specific adult disorders."

It is particularly gratifying to prepare a second edition of a book, because there is the necessary impli cation that the first edition was well received. Moreover, now an opportunity is provided to correct the problems or limitations that existed in the first edition as well as to address recent developments in the field. Thus, we are grateful to our friends, colleagues, and students, as well as to the reviewers who have expressed their approval of the first edition and who have given us valuable input on how the revision could best be structured. Perhaps the first thing that the reader will notice about the second edition is that it is more extensive than the first. The volume currently has 41 chapters, in contrast to the 31 chapters that comprised the earlier version. Chapters 3, 9, 29, and 30 of the first edition either have been dropped or were combined, whereas 14 new chapters have been added. In effect, we are gratified in being able to reflect the continued growth of behavior therapy in the 1980s. Behavior therapists have addressed an ever-increasing number of disorders and behavioral dysfunctions in an increasing range of populations. The most notable advances are taking place in such areas as cognitive approaches, geriatrics, and behavioral medicine, and also in the treatment of childhood disorders."

In the last decade there has been heightened clinical and investigative activity in the area of family violence. This, of course, is partly attributable to recent surveys showing a high incidence of family violence in the United States. For example, there are indications that nearly 30% of married women in this country are victims of physical abuse by spouses at some point in their marriage. Further, FBI statistics show that approximately 13% of all homicides are husband-wife killings. Moreover, it has been projected that such figures are likely to increase over the next several years. Consistent with these trends, funding of family violence research by both federal and private agencies has increased. Indeed, federal agencies, such as the National Institute of Mental Health and the National Institute of Law Enforcement and Criminal Justice, have provided considerable support for work in this area. In addition, family violence, particu larly wifebattering, child abuse, and sexual abuse of children has been the focus of media attention at the national level, and has generated intensive interest in both lay and profes sional publications. Moreover, there have been several recent governmental hearings and investigations regarding the prevalence of these problems."

Research on the nature and treatment of schizophrenia has undergone a revival and metamorphosis in the last decade. For a long while, the field had been moribund, weighed down by an unreliable diagnostic system, pessi mism about the possibility of new discoveries, and a dearth of research funds. A number of factors have seemingly coalesced to change this situa tion, with the result that the field is now alive with excitement and optimism. Four factors seem to have played important roles in the resurgence of interest. First, prior to the publication of DSM-III in 1980 there was no reliable diagnostic system for the disorder. Previous definitions were overly general and imprecise. Consequently, the label "schizophrenia" applied to a very heterogeneous group of severely disturhed patients. It was rarely clear whether two investigators had studied comparable samples, making it im possible to determine if (flew findings were generalizahle or if failures to replicate were due to the unreliahility of the results or the fact that the investigators had studied different disorders. DSM-III has not totally re solved this problem, but it has allowed scientists to reliably identify a much more homogeneous group. As a result, it is now possible to integrate the results of different studies, making it much more likely that we can make important advances. The second important factor was the development of new technologies that promised to help uncover the nature and etiology of the disorder."