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Substance Abuse and Schizophrenia: Pharmacological Approaches

ABSTRACT This brief report reviews the common co-occurrence of substance use disorder in patients with schizophrenia, and its negative consequences. We suggest that a neurobiological basis for the co-occurring disorder may be important, and may relate to a dysfunctional brain reward circuit in these patients. The atypical antipsychotic medication clozapine appears to have an unusual ability to limit substance abuse in patients with schizophrenia, and other atypical antipsychotics may share at least some of this effect of clozapine. We have proposed that clozapine's ability to limit substance abuse in patients with schizophrenia may be due to its broad spectrum of pharmacological effects that serve to ameliorate the dysfunctional brain reward circuit. We have also proposed that neuroimaging techniques may be used to identify brain reward circuit dysfunction, and to track the effects of pharmacological agents that may limit substance abuse in these patients. Finally, we note the existence of a number of new agents for the treatment of alcoholism, and indicate that some of these medications may be used adjunctively in patients with schizophrenia to limit alcohol abuse.