Clozapine, Olanzapine, or Typical Antipsychotics for Alcohol Use Disorder in Patients With Schizophrenia

Abstract

Objectives: Previous research regarding the impact of olanzapine on substance use in patients with schizophrenia is mixed, and no data address its impact on alcohol use disorders. This retrospective study compared the effect of olanzapine to the effect of clozapine, an agent associated Mary F. Brunette, Christopher O'Keefe, and Alan I. Green are affiliated with the Department of Psychiatry, Dartmouth Medical School, White River Junction, VA. Brunette et al. 345 with improvements in alcohol use disorders in patients with schizophrenia, and to the effect of typical antipsychotic medications, which have not been associated with improvements in alcohol use disorders in these patients. We hypothesized that patients taking olanzapine would be more likely to become abstinent than those treated with typical antipsychotics but less likely to become abstinent than patients treated with clozapine. Methods: Data were collected by chart review. Results: Olanzapine treatment was more likely to be associated with abstinence than treatment with typical antipsychotics (chi-square = 4.22, df = 1, p = .040) and less likely to be associated with abstinence than clozapine treatment (chi-square = 13.02, df = 1, p = .0001). The majority of patients in the three medication groups were deemed improved in their psychiatric status. Conclusions: While these results should be interpreted with caution, the analyses reported here suggest that olanzapine may be more helpful for the treatment of alcohol disorders in patients with schizophrenia spectrum disorders than typical antipsychotics, but the impact appears to be small compared to the impact of clozapine, which seems more promising. This retrospective study adds to a growing literature suggesting that clozapine may be particularly helpful for the treatment of alcohol disorders in patients with schizophrenia.

Effects of clozapine treatment on the improvement of substance use disorders other than nicotine in individuals with schizophrenia spectrum disorders: A systematic review and meta-analysis

“…Four observational studies (Brunette et al, 2006, 2008; Drake et al, 2000; Green et al, 2003) with available raw data reported the proportion of individuals with concurrent SSD and SUDs (predominantly alcohol) who remained abstinent (defined as either complete cessation of use or use without impairment) on clozapine versus other antipsychotics for the duration of follow-up. Characteristics of these studies are shown in Table 2.…”

The link between schizophrenia and substance use disorder: A unifying hypothesis

“…An important related issue concerns the effects of antipsychotic medication on substance use in this population. Most antipsychotics do not lessen substance use in patients with schizophrenia, with one exception – clozapine has been shown in many (albeit still preliminary) studies to do so across a variety of substances (e.g., alcohol, cannabis, tobacco) (Brunette et al, 2011; Brunette et al, 2006; Brunette et al, 2008; Buckley et al, 1999; Drake et al, 2000; George et al, 1995; Lee et al, 1998; Wu et al, 2013; Zimmet et al, 2000). Related to this, Mesholam-Gately et al, (2014) have observed, in a population of substance using patients with schizophrenia that in comparison with other antipsychotics, clozapine strengthens the hedonic experience associated with olfactory stimuli.…”

A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia

“…Unfortunately, available data are somewhat mixed and not overly promising (Green, Noordsy, Brunette, & O’Keefe, 2008) for risperidone (Green, Burgess, Dawson, Zimmet, & Strous, 2003; Smelson et al, 2002; Smelson et al, 2004), olanzapine (Akerele & Levin, 2007; M.F. Brunette et al, 2008; Noordsy et al, 2001; Petrakis, Leslie, Finney, & Rosenheck, 2006; Smelson et al, 2006), quetiapine (E.…”