Chapter 11 - Substance use in persons with schizophrenia: incidence, baseline correlates, and effects on outcome

Summary

One unintended consequence of shifting care for patients with schizophrenia away from institutional settings to the community has been exposing them to a much greater risk of using substances of abuse. The diagnosis of schizophrenia was made using DSM-IV criteria as confirmed by the SCID. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study incorporated arguably the most exhaustive substance use assessment methods ever conducted in patients with schizophrenia in a clinical trial setting, combining reports from multiple informants, clinical assessment, drug urine testing, and radioimmunoassay of hair specimens (RIAH). The careful substance abuse screening conducted in the CATIE trial provides important information for the planning of future research. As opposed to almost all clinical trials, patients with co-morbid substance disorders were included and almost 4 out of 10 subjects qualified for an illicit substance abuse diagnosis or used illicit drugs.