Vol 8, No 1 Diagnosis and Management of Schizophrenic Disorders
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he high frequency of co-occurring substance use disorder in schizophrenia is linked to an increased risk of illness and injury.1 Apart from impaired cognitive functioning during intoxication, substance misuse is asso- ciated with poorer outcomes in psychosis and higher rates of presentation to inpatient and emergency ser- vices.2 Another problem relates to the high occurrence of incarceration, predominately among persons with a diag- nosis from the schizophrenia spectrum, who are actively abusing substances.3 It is primarily these individuals, with comorbidity of schizophrenia and drug addiction and who lack stable housing, who run a high risk of being incarcerated. Thus, comorbid substance abuse disorders in schizophrenic patients have been shown to be a con- siderable obstacle to carrying out effective treatment.The development of effective intervention programs demands a global understanding of the risk factors for developing a comorbid substance disorder, as well as the conse- quences of substance abuse in schizophrenia. Epidemiology Epidemiological research in this field focuses on the identification of risk factors, the temporal relationship of the onsets of the disorders, and on specific symptoms.The proportion of schizophrenic patients with comorbidity of substance abuse varies in published studies from 10% to 70%, depending on how patients are diagnosed with schizophrenia, the types of populations studied, and the different ways of defining drug and alcohol disorders.4 However, an increasing number of publications demon- 3 7 P h a r m a c o l o g i c a l  a s p e c t s T Copyright © 2006 LLS SAS.  All rights reserved www.dialogues-cns.org Substance abuse in patients with schizophrenia Bernadette Winklbaur, MD; Nina Ebner, MD; Gabriele Sachs, MD; Kenneth Thau, MD; Gabriele Fischer, MD Keywords: schizophrenia; substance abuse; comorbidity; epidemiology;
neurobiological aspects; intervention Author affiliations: Department of Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria Address for correspondence: Gabriele Fischer, MD, Department of Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria (e-mail: gabriele.fischer@meduniwien.ac.at) The comorbidity of schizophrenia and substance abuse has attracted increasing attention in the past years, with multiple potential links, including genetic vulnerability, neurobiological aspects, side effects of medications, and psychosocial factors being under discussion. The link between the use of substances and the development of psychoses is demonstrated by the high prevalence of substance abuse in schizophrenia. Apart from alcohol misuse,  substances  commonly  abused  in  this  patient group include nicotine, cocaine, and cannabis. In partic- ular, heavy cannabis abuse has been reported to be a stressor eliciting relapse in schizophrenic patients. In gen- eral, substance use in psychosis is associated with poorer outcomes, including increased psychotic symptoms and poorer treatment compliance. Since both disorders have been observed to be closely interdependent, a particu- lar treatment for schizophrenic patients with comorbid- ity of substance abuse is needed in order to provide more effective care. In this article, we discuss various potential modes of interaction and interdependence, and the possibility of embarking on new therapeutic paths for treating this particular population.   © 2006, LLS SAS Dialogues Clin Neurosci. 2006;8:37-43.