Pharmacology: Dual Disorders

\r\n Pharmacological management of both the psychiatric and the substance use disorder is an important foundation of the treatment of clients with co-occurring severe mental illness and substance use disorder. In all of the above psychosocial studies, clients in psychosocial treatment research also received medication management, which was rarely accounted for in analyses. Research on the effects of medications themselves, however, is in its infancy. Thus far research suggests two main points. First, medications shown to be effective for the treatment of alcohol disorders in the general population, such as disulfuram and naltrexone, are probably effective also in clients with serious mental illness Second, some medications that treat the mental illness may lead to reduction in the severity of the substance use disorder.

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\r\n Antidepressants appear to reduce not only symptoms of depression but also alcohol use in clients with major depression and alcohol disorder Mood stabilizers are active not only on mania but also on alcohol use in clients with bipolar disorder and comorbid alcohol dependence Typical antipsychotics improve the symptoms of schizophrenia but have little effect on co-occurring substance use. Most of the newer (atypical) antipsychotics are equally effective as the typical antipsychotics in improving schizophrenia symptoms and may offer some benefit in reducing craving or substance use, but research is preliminary Clozapine is clearly the most powerful drug in treating schizophrenia symptoms and, at least in quasi-experimental studies, appears to be at the same time the most effective antipsychotic medication in relation to substance use.

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