Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders.
BACKGROUND
Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds.


METHODS
To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care.


RESULTS
Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups.


CONCLUSIONS
Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.
Brunette
Mary F
MF
Department of Psychiatry, Dartmouth Medical School, New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH 03301, USA. Mary.F.Brunette@dartmouth.edu
Drake
Robert E
RE
Xie
Haiyi
H
McHugo
Gregory J
GJ
Green
Alan I
AI
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009513:New Hampshire; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D012008:Recurrence; D012074:Remission Induction; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*
D014150:Antipsychotic Agents; D003024:Clozapine