Other than nicotine, alcohol is the most commonly abused drug in patients with schizophrenia. Schizophrenia occurs in about 1% of the population, but ECA data revealed that 33.7% of people with schizophreniform disorder (same symptoms as schizophrenia but lasting less than 6 months) or schizophrenia have a diagnosis of alcohol abuse or alcohol dependence at some time in their lives. The high rate of alcohol use disorders in patients with schizophrenia may be related to biological factors, such as self-medication to alleviate symptoms of schizophrenia, or side effects of antipsychotic medications; underlying abnormalities of dopamine regulation may provide a common basis for the high rate of co-occurrence; or patients with schizophrenia may be particularly vulnerable to the negative effects of substance use due to the impaired thinking and impaired social judgment that are part of the schizophrenic syndrome, thus increasing their vulnerability for a substance use disorder. It is critical that the treatment for schizophrenia and alcohol use disorders be integrated. This involves multidisciplinary treatment teams that provide outreach and comprehensive services. Osher and Kofoed (1989) describe four stages that are effective with patients with comorbid schizophrenia and alcohol use disorders: (1) developing a trusting relationship; (2) motivating the patient to manage both illnesses and pursue recovery goals; (3) providing active treatment that includes development of skills and supports needed for illness management and recovery; and (4) developing relapse prevention strategies to avoid and minimize the effects of relapse.

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