Substance abuse among patients with schizophrenia

Substance use in the general population is a significant public health problem. Problems associated with substance use are aggravated by concomitant psychiatric illness, particularly schizophrenia and schizoaffective disorder. Although there is a general agreement on the need to address this problem, a wide range of opinions exists on exactly what is the best modality. In this article, we provide a brief overview of the etiology and consequences of substance use in individuals with schizophrenia, followed by a more detailed review of pharmacological and psychotherapeutic trends in the treatment of this population. Research studies indicate that, while some evidence supports the self-medication hypothesis, individuals with schizophrenia or schizoaffective disorder frequently use substances for the same reasons and in the same manner as the general population. In the pharmacotherapy section, we briefly discuss the rationale for current medication strategies, their efficacy, and directions for future research. This is followed by an assessment of current psychotherapeutic interventions, their limitations, and potential modifications to improve treatment outcome. The research literature suggests that integrated treatment and well-tailored interventions that take into account psychosocial factors and motivation offer the most promise for the future. More controlled trials are necessary to validate this hypothesis.