Substance use disorders in schizophrenia: review, integration, and a proposed model

Substance use disorders occur in approximately 40 to 50% of individuals with schizophrenia. Clinically, substance use disorders are associated with a variety of negative outcomes in schizophrenia, including incarceration, homelessness, violence, and suicide. An understanding of the reasons for such high rates of substance use disorders may yield insights into the treatment of this comorbidity in schizophrenia. This review summarizes methodological and conceptual issues concerning the study of substance use disorders in schizophrenia and provides a review of the prevalence of this co-occurrence. Prevailing theories regarding the co-occurrence of schizophrenia and substance use disorders are reviewed. Little empirical support is found for models suggesting that schizophrenic symptoms lead to substance use (self-medication), that substance use leads to schizophrenia, or that there is a genetic relationship between schizophrenia and substance use. An integrative affect-regulation model incorporating individual differences in traits and responses to stress is proposed for future study.