Alcohol and Other Substance Abuse Disorders

Substance abuse disorders complicate schizophrenia at rates that exceed those found in the general population. The Epidemiologic Catchment Area study (Regier et al. 1990) found the rate of comorbid substance abuse as 47% in schizophrenia. Alcohol accounted for 34% of this estimated rate, a figure substantially higher than that for the general population (14%). Another recent investigation concluded that individuals with schizophrenia report rates of 16% for lifetime nonalcohol substance abuse (Duke et al. 2001). The most commonly abused substances include marijuana, stimulants, hallucinogens, opiates, and anticholinergics, and abuse was concentrated in males younger than 36 years. The suggested source of this increased vulnerability to addictive behaviors among schizophrenic patients is disturbance in the neural circuitry mediating drug desire and reinforcement. Chambers et al. (2001) argued that abnormalities in the hippocampal formation and frontal cortex (leading to disturbed dopamine and glutamate signaling in the nucleus accumbens) facilitate the positive reinforcing effects of drug reward and reduce inhibitory controls over drug-seeking behavior. See Chapter 9, "Substance Use Disorders in Schizophrenia," for a more complete discussion.

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