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Review: Treatments for Co-Occurring Schizophrenia and Substance Use Disorders


The prevalence of co-occurring schizophrenia and substance use disorders varies between 47% and 70%, and the rate of co-occurring substance abuse among individuals with schizophrenia is nearly three times as high as the general population. Substance use disorders exert a significant negative impact on schizophrenia, including poor treatment adherence. This review examined the use of first- and second-generation antipsychotics for the treatment of co-occurring substance use disorders among people with schizophrenia, and also assessed the use of psychosocial interventions and adjunctive pharmacotherapies. Investigators found a lack of rigorously controlled studies that focused on individuals with co-occurring schizophrenia and substance use disorders. While studies to date suggest better outcomes with second-generation antipsychotics (SGAs), for example, olanzapine and risperidone, the available evidence does not clearly demonstrate an advantage for any particular SGA; thus investigators recommend that clinicians select the medication that balances efficacy and side effects for each individual patient. However, findings do suggest that comprehensive treatment must include specialized integrated psychosocial intervention. In addition, there is growing evidence for the efficacy of specific pharmacotherapies for substance use disorders (e.g., naltrexone and disulfiram) in patients with schizophrenia.

Review: Treatments for Co-Occurring Schizophrenia and Substance Use Disorders

The prevalence of co-occurring schizophrenia and substance use disorders varies between 47% and 70%, and the rate of co-occurring substance abuse among individuals with schizophrenia is nearly three times as high as the general population. Substance use disorders exert a significant negative impact on schizophrenia, including poor treatment adherence. This review examined the use of first- and second-generation antipsychotics for the treatment of co-occurring substance use disorders among people with schizophrenia, and also assessed the use of psychosocial interventions and adjunctive pharmacotherapies. Investigators found a lack of rigorously controlled studies that focused on individuals with co-occurring schizophrenia and substance use disorders. While studies to date suggest better outcomes with second-generation antipsychotics (SGAs), for example, olanzapine and risperidone, the available evidence does not clearly demonstrate an advantage for any particular SGA; thus investigators recommend that clinicians select the medication that balances efficacy and side effects for each individual patient. However, findings do suggest that comprehensive treatment must include specialized integrated psychosocial intervention. In addition, there is growing evidence for the efficacy of specific pharmacotherapies for substance use disorders (e.g., naltrexone and disulfiram) in patients with schizophrenia.

Drs. Smelson and Remolina are part of the VA New Jersey Healthcare System. Dr. Dixon is with the VA Mental Illness Research, Education and Clinical Centers (MIRECC) in VISN 4; Dr. Batki is part of the San Francisco VAMC; and Dr. Owen is the Research Coordinator for VA/HSR&D’s Mental Health Quality Enhancement Research Initiative (QUERI).

PubMed Logo Smelson D, Dixon L, Craig T, Remolina S, Batki S, Niv N, and Owen R. Pharmacological treatment of schizophrenia and co-occurring substance use disorders. CNS Drugs 2008;22(11):903-16.

Drs. Smelson and Remolina are part of the VA New Jersey Healthcare System. Dr. Dixon is with the VA Mental Illness Research, Education and Clinical Centers (MIRECC) in VISN 4; Dr. Batki is part of the San Francisco VAMC; and Dr. Owen is the Research Coordinator for VA/HSR&D’s Mental Health Quality Enhancement Research Initiative (QUERI).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.