Treatment programming for individuals diagnosed with a chronic mental illness and an alcohol use disorder could be enhanced by employing techniques that focus on those change process variables that are most strongly related to psychiatric distress. Prochaska and DiClemente's transtheoretical model (TTM) provides a useful framework within which to study these relations. The associations between psychiatric severity and the TTM constructs of stages and processes of change, decisional balance, temptation, and self-efficacy were measured among 132 alcohol-dependent patients in a public mental health clinic's outpatient dual diagnosis program. Participants' scores on the Temptation subscale of the Alcohol Abstinence Self-Efficacy Questionnaire are strongly related to psychiatric severity: The more psychiatric distress a person is experiencing, the more he or she is tempted to drink, particularly in situations that trigger negative affect. Decisional balance considerations are also related to psychiatric severity: The higher participants scored on the Global Severity Index of the Brief Symptom Inventory, the more importance they placed on the negative aspects, or cons, of drinking. Subjects with more psychiatric distress also scored higher on the maintenance stage of change subscale, possibly indicating an increased fear of relapse and struggle to maintain sobriety.