Clozapine Use and Relapses of Substance Use Disorder Among Patients With Co-occurring Schizophrenia and Substance Use Disorders

Abstract

Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.

Substance abuse and schizophrenia: Pharmacotherapeutic intervention

“…Among the 36 patients who received clozapine treatment for schizophrenia symptoms, remission rates for alcohol and cannabis use disorders were 67-79%, compared to 34% among the 115 patients taking typical antipsychotics. Moreover, in a 10-year follow-up report from this same study group, patients in remission who were treated with clozapine were less likely to relapse over the subsequent year (8%) than those who were treated with other antipsychotics (40%) (Brunette, Drake, Xie, McHugo, & Green, 2006). Zimmet and colleagues also reported on a retrospective survey of patients with schizophrenia or schizoaffective disorder and substance use disorder treated with clozapine.…”

Managing cannabis use in people with severe mental illness: what can be done?

“…In a prospective study involv ing alcohol and cannabisusing patients with schizophrenia and schizoaffective disorder, those receiving clozapine had significantly better remission rates for sub stance use than those on typical antipsychotics (Drake 2000). A 10year followup report from the same group showed that individuals taking clozapine were less likely to relapse into substance use over the subsequent year than those treated with other antipsychotics (Brunette 2006b). In a retrospective survey of 58 clozapine clinic patients with schizophrenia or schizoaffective disorder and substance use, a significant reduction in cannabis, alcohol and cocaine use was recorded in those who continued to take clozapine, compared with those who discontinued it (Zimmet 2000).…”

Santé mentale, alcool/drogues et violence. Adaptation du modèle tripartite de Goldstein

“…Ceci expliquerait, d'une part, pourquoi, sur un échantillon de 58 schizophrènes présentant un trouble lié à une substance, Zimmet et al (2000) ont observé que 85 % d'entre eux avaient diminué leur consommation après avoir débuté un traitement à la clozapine. Dans le même sens, Brunette, Drake, Xie, McHugo et Green (2006) ont noté moins de rechutes chez ceux ayant cessé leur consommation suite à l'application d'un tel traitement.…”

“…Bien que la clozapine soit pour l'instant l'antipsychotique atypique le plus souvent associé à une stabilisation de l'état mental, à une diminution des états de besoin 1 de cocaïne et à une réduction de la consommation de substances intoxicantes chez les individus présentant à la fois un trouble sévère et persistant et un trouble lié à une substance, d'autres antipsychotiques atypiques tels que la quétiapine, l'olanzapine ou la rispéri-done se sont également révélés efficaces dans le traitement de cette double problématique et mériteraient, par conséquent, d'être étudiés davantage (Noordsy, O'Keefe, Mueser & Xie, 2001 ;Smelson, Losonczy, Davis, Kaune, Williams & Ziedonis, 2002 ;Brown, Netjek, Perantie & Bobadilla, 2002 ;Green, 2006 ;Stuyt, Sabjel & Allen, 2006).…”