Schizophrenia, substance misuse, and smoking

The recent literature suggests that enriched genetic loading for substance use disorders, a desire to relieve the subjective distress associated with schizophrenia and its treatment, and 'therapeutic' effects of nicotine may contribute to the high prevalence rates for substance use disorder and smoking among patients with schizophrenia. Substance use disorder is associated with homelessness, aggression, and violence, and increased medical morbidity and mortality in this population. Comprehensive, integrated, outpatient programs that include assertive outreach, case management, and a longitudinal, stepwise, motivational approach to substance use disorder show the most promise. Curr Opin Psychiatry 13:15-19. (C) 2000 Lippincott Williams & Wilkins.