Pharmacological treatment of schizophrenia and co-occurring substance use disorders.
Substance abuse among individuals with schizophrenia is common and is often associated with poor clinical outcomes. Comprehensive, integrated pharmacological and psychosocial treatments have been shown to improve these outcomes. While a growing number of studies suggest that second-generation antipsychotic medications may have beneficial effects on the treatment of co-occurring substance use disorders, this review suggests that the literature is still in its infancy. Few existing well controlled trials support greater efficacy of second-generation antipsychotics compared with first-generation antipsychotics or any particular second-generation antipsychotic. This article focuses on and reviews studies involving US FDA-approved medications for co-occurring substance abuse problems among individuals with schizophrenia.Comprehensive treatment for individuals with schizophrenia and co-occurring substance use disorders must include specialized, integrated psychosocial intervention. Most approaches use some combination of cognitive-behavioural therapy, motivational enhancement therapy and assertive case management. The research on antipsychotic and other pharmacological treatments is also reviewed, as well as psychosocial treatments for individuals with schizophrenia and co-occurring substance use disorders, and clinical recommendations to optimize care for this population are offered.
Smelson
David A
DA
Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, Massachusetts, USA. David.Smelson@umassmed.edu
Dixon
Lisa
L
Craig
Thomas
T
Remolina
Stephen
S
Batki
Steven L
SL
Niv
Noosha
N
Owen
Richard
R
D000437:Alcoholism / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D009293:Opioid-Related Disorders / Q000188:drug therapy; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D014150:Antipsychotic Agents