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Psychosocial Treatment of Patients with
Schizophrenia and Substance
John Tsuang, MD, MS,*† Timothy W. Fong, MD,† and Ira Lesser, MD*†
Substance abuse among patients with schizophre-
nia is quite common, with at least half of these
individuals having a lifetime diagnosis of a sub-
stance abuse disorder. These so called ‘‘dual di-
agnosis’’ or ‘‘co-occurring disorder’’ patients have
an increased utilization of medical and psychiatric
have a worse prognosis as compared with non-
substance abusing patients with schizophrenia.
Fortunately,in recentyears,the treatment ofdually
diagnosed patients has significantly improved. It
has been established that the best treatment of
these patients includes enrollment in an integrated
program that treats both mental illness and sub-
stance abuse problems simultaneously. Previously,
we published an article that reviewed the available
psychopharmacological options for treatment of
co-occurring disorder patients. This article will
focus more on the psychosocial treatment mo-
dalities that have been used to reduce the psychi-
atric morbidity and substance relapse in these
Key Words: first key word, second key word, third
( Addict Disord Their Treatment 2005;00:000–000)
OVERVIEW OF THE PROBLEM
Dual diagnosis patients are those suffer-
ing from concurrent substance abuse disor-
ders and psychiatric conditions, such as
schizophrenia. According to a recent study,
schizophrenia occurs in about 1 to 2% of the
population.1The prevalence of a substance
use disorder (abuse or dependence) among
the general population is approximately 16%.
It is estimated that lifetime substance-abuse
problems are found in 47% of the individuals
with schizophrenia, and the odds of having
a substance abuse diagnosis are 4.6 times
higher among these patients as compared
with the general population.1This higher rate
of co-occurrence of substance abuse by pa-
tients with schizophrenia has been reported
in other studies, with rates of substance mis-
use ranging from 25% to 75%.2–4When sep-
arating this into alcohol and drug abuse
have a lifetime of alcohol-abuse/dependence
diagnosis and 28% have a lifetime of drug
abuse/dependence diagnosis. These numbers
are significantly higher than rates among the
general population, for whom alcohol prob-
lems is 13.5% and drug abuse diagnosis is
The comorbidity of these disorders has
significant negative consequences. Research
has suggested that the co-occurrence of a psy-
chiatric disorder and substance abuse prob-
lem leads to a higher rate of medical illnesses
such as HIVand Hepatitis B and C.5,6The use
of illicit drugs by patients with schizophrenia
could lead to exacerbation of psychotic and
depressive symptoms, increased suicide at-
tempts, more frequent hospitalizations, and
poorer prognosis.7–11These patients were
8 times more likely to be noncompliant with
taking medication than those without comor-
bid substance abuse disorders.8,12In addition
to the negative impact on disease course and
also added a greater financial burden to our
society by being more likely to be homeless,
involved in violence, and incarcerated or
hospitalized.9,13–15Thus, it is imperative that
Volume 00, Number 0
From the *Harbor-UCLA Medical
Center and Los Angeles
Biomedical Research Institute at
Harbor/UCLA; and †Department
of Psychiatry & Biobehavioral
Sciences, Geffen School of
Medicine at UCLA.
Reprints: John Tsuang, Harbor-
UCLA Medical Center & Los
Angeles Biomedical (e-mail:
Copyright ? 2005 by
Lippincott Williams & Wilkins
JOBNAME: adtt 00#0 2005 PAGE: 1 OUTPUT: Thu October 6 7:16:30 2005
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