Substance abuse (including nicotine) in schizophrenic patients

Purpose of review: Comorbid substance-use disorders are present in at least 25% of patients with schizophrenia, and 70-80% of these patients smoke. It is important to understand how substance-use disorders affect outcomes in this already impaired population. Recent findings: Substance-use disorders occur most commonly in males, and are most prevalent in the young. Substance-use disorders are associated with bad outcomes, including medication non-compliance, rehospitalization, homelessness, contact with the criminal justice system, medical morbidity and suicide, and these bad outcomes seem to be more likely among those patients who utilize multiple drugs rather than alcohol alone. Psychosocial and behavioral treatments produce few successes. Early indications suggest that clozapine may reduce substance-use disorders. Nicotine corrects certain neurophysiological deficits (e.g. eye-tracking abnormalities) in patients with schizophrenia. Maternal smoking during pregnancy may increase the likelihood of antisocial behavior and substance-use disorder in the offspring. Atypical antipsychotics plus bupropion increase the likelihood of smoking reduction/cessation in patients with schizophrenia. Summary: The recent literature clearly documents the devastating effects of comorbid substance-use disorders in schizophrenia. Promising new treatment options will require further study.