Substance Abuse in Schizophrenia: A Review

Approximately half of the patients who suffer from schizophrenia are also substance abusers at sometime during their illness. The motivational drive toward abusive consumption is compounded in individualswith schizophrenia who turn toward substances with reinforcing properties to alleviate aspects ofpsychosis. This review examines the prevalence, etiology, and clinical effects of substance abuse (e.g.,alcohol, nicotine, cocaine) among individuals with schizophrenia. Clearly, substance abuse persists despiteand in spite of treatment with typical antipsychotics. The efficacy of newer generation antipsychoticsin the reduction of substance abuse among the schizophrenic population has yet to be established, butclozapine has been shown to reduce alcohol, smoking, and cocaine use. Hence, clozapine is a therapeuticoption for dually diagnosed patients because of its superior efficacy relative to conventional neurolepticsand its capacity to control substance abuse.