Pharmacotherapy of psychiatric syndromes with comorbid chemical dependence

Because of the paucity of research on the pharmacotherapy of psychiatric syndromes with comorbid psychoactive substance use disorders, treatment guidelines are primarily drawn from general principles of clinical psychopharmacology and the addictive disease model. Effective treatment requires the determination of a discrete psychiatric diagnosis or working differential, consideration of the range of drug effects as they vary over time, and awareness of potential pharmacologic interactions between medication and alcohol or drug use. Either nonspecific prescribing or failure to treat may result in protracted dysfunction, relapse, or medical morbidity and mortality. Pharmacotherapy may also determine whether treatment results in mere abstinence vs. recovery from addictive disease. Primary emphasis on non-pharmacologic strategies and the use of a formal treatment contract increase the likelihood of successful pharmacotherapy outcome.