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. 2014 Dec;1(4):251-260.
doi: 10.1007/s40429-014-0034-7. Epub 2014 Sep 27.

Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders

Sarah C Akerman  1 , Mary F Brunette  1 , Douglas L Noordsy  1 , Alan I Green  1
Affiliations

Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders

Sarah C Akerman et al. Curr Addict Rep. 2014 Dec.

Abstract

Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.

Keywords: Antipsychotic; Brain reward; Clozapine; Schizophrenia; Substance use disorder.

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Conflict of interest statement

Conflict of Interest Sarah Akerman has received research grant support, unrelated to this article, from the Dartmouth Clinical and Translational Science Institute, under funding from the National Center for Advancing Translational Science of the NIH (#UL1TR001086). Mary Brunette has received research grant support from the National Cancer Institute, unrelated to this article. Douglas Noordsy has received a consultancy fee from Ostuka, grants from NIDA, NIAAA and Alkermes and royalties from Guildord Press, all unrelated to this article. Alan Green has received research grants from NIH, and from Janssen, Astra Zeneca and Novartis, has served on a Data Monitoring Board for Eli Lilly, and has been an unpaid consultant to Otsuka and Alkermes. He also has 2 pending patent applications regarding the treatment of substance abuse.

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