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Schizophrenia Bulletin Advance Access originally published online on June 16, 2006
Schizophrenia Bulletin 2006 32(4):637-643; doi:10.1093/schbul/sbl003
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

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

Mary F. Brunette1,23, Robert E. Drake2,3, Haiyi Xie2,3, Gregory J. McHugo2,3 and Alan I. Green2
2 Department of Psychiatry, Dartmouth Medical School
3 New Hampshire-Dartmouth Psychiatric Research Center, Main Building Level 2, State Office Park South, 105 Pleasant Street, Concord, NH 03301

1To whom correspondence should be addressed; tel: 603-271-5747, fax: 603-271-5265, e-mail: Mary.F.Brunette{at}dartmouth.edu.

Background: Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. Methods: To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. Results: Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, {chi}2 = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. Conclusion: Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.

Keywords: schizophrenia / substance use disorder / clozapine / antipsychotic medication / relapse


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A. I. Green, R. E. Drake, M. F. Brunette, and D. L. Noordsy
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Am J Psychiatry, March 1, 2007; 164(3): 402 - 408.
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