© 2000 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
The Effects of Clozapine on Alcohol and Drug Use Disorders Among Patients With Schizophrenia
Director of the New Hampshire-Dartmouth Psychiatric Research Center, and Professor of Psychiatry, Dartmouth Medical School Lebanon, NH
research psychologist at the New Hampshire-Dartmouth Psychiatric Research Center, and Research Associate Professor, Department of Community and Family Medicine, Dartmouth Medical School
statistician at the New Hampshire-Dartmouth Psychiatric Research Center, and Research Assistant Professor, Department of Community and Family Medicine, Dartmouth Medical School
Director, Commonwealth Research Center, Massachusetts Mental Health Center and Associate Professor of Psychiatry, Harvard Medical School Boston, MA
Send reprint requests to Dr. R. Drake, Psychiatric Research Ctr 2 Whipple Place, Lebanon, NH 03766; email: Robert.E.Drake{at}Dartmouth.edu
Several case studies indicate that clozapine use is associated with reductions in the use of nicotine, alcohol, or illicit drugs. Although not designed to assess clozapine, this study explored a posteriori the effects of clozapine on alcohol and drug use disorders among schizophrenia patients. Among 151 patients with schizophrenia or schizoaffective disorder and co-occurring substance use disorder who were studied in a dual-disorder treatment program, 36 received clozapine during the study for standard clinical indications. All participants were assessed prospectively at baseline and every 6 months over 3 years for psychiatric symptoms and substance use. Alcohol-abusing patients taking clozapine experienced significant reductions in severity of alcohol abuse and days of alcohol use while on clozapine. For example, they averaged 54.1 drinking days during 6-month intervals while off clozapine and 12.5 drinking days while on clozapine. They also improved more than patients who did not receive clozapine. At the end of the study, 79.0 percent of the patients on clozapine were in remission from alcohol use disorder for 6 months or longer, while only 33.7 percent of those not taking clozapine were remitted. Findings related to other drugs in relation to clozapine were also positive but less clear because of the small number of patients with drug use disorders. This study was limited by the naturalistic design and the lack of prospective, standardized measures of clozapine use. The use of clozapine by patients with co-occurring substance disorders deserves further study in randomized clinical trials.
Keywords: Schizophrenia / substance abuse / substance use disorder / clozapine
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