Drugs

, Volume 62, Issue 5, pp 743–755

Substance Misuse in Patients with Schizophrenia

Epidemiology and Management
  • David J. Kavanagh
  • John McGrath
  • John B. Saunders
  • Glenys Dore
  • Dianne Clark
Therapy in Practice

Abstract

Substance misuse in individuals with schizophrenia is very common, especially in young men, in communities where use is frequent and in people receiving inpatient treatment. Problematic use occurs at very low intake levels, so that most affected people are not physically dependent (with the exception of nicotine). People with schizophrenia and substance misuse have poorer symptomatic and functional outcomes than those with schizophrenia alone. Unless there is routine screening, substance misuse is often missed in assessments. Service systems tend to be separated, with poor inter-communication, and affected patients are often excluded from services because of their comorbidity. However, effective management of these disorders requires a fully integrated approach because of the close inter-relationship of the disorders. Use of atypical antipsychotics may be especially important in this population because of growing evidence (especially on clozapine and risperidone) that nicotine smoking, alcohol misuse and possibly some other substance misuse is reduced. Several pharmacotherapies for substance misuse can be used safely in people with schizophrenia, but the evidence base is small and guidelines for their use are necessarily derived from experience in the general population.

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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • David J. Kavanagh
    • 1
  • John McGrath
    • 1
    • 2
  • John B. Saunders
    • 1
    • 3
  • Glenys Dore
    • 4
  • Dianne Clark
    • 1
  1. 1.Department of Psychiatry, School of MedicinUniversity of Queensland Mental Health Centre, Royal Brisbane HospitalHerstonAustralia
  2. 2.Queensland Centre for Schizophrenia ResearchWacolAustralia
  3. 3.Alcohol and Drug Services of the Royal Brisbane Hospital and The Prince Charles Hospital Health Service DistrictsBrisbaneAustralia
  4. 4.Macquarie Hospital and Department of Psychological MedicineUniversity of SydneyNorth RydeAustralia

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