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Headlines*: May 2006

* Newsletter of NISAD (Neuroscience Institute of Schizophrenia and Allied Disorders)

Schizophrenia and Substance Use

Breaking the Cycle of Cigarette and Cannabis Smoking

People with schizophrenia have consistently been shown to have very high rates of cigarette smoking. Up to 88 percent of all patients smoke, as compared to 25 per cent of the general population. Some studies have linked this high rate to the clinical characteristics of schizophrenia, suggesting that the gene for the alpha 7-nicotinic receptor may play a role in the pathogenesis of the illness and may also be responsible for the heavy smoking among patients. However, as this high smoking rate represents a significant health and financial cost to patients, other studies are exploring ways to help them quit.

Supported by NISAD, one such study¹conducted at the Centre for Mental Health Studies (CMHS), University of Newcastle, recruited 298 regular smokers with a psychotic disorder. Half the group participated in a 12-month intervention therapy program, and the other half in their usual care control program. The intervention program consisted of nicotine replacement therapy, plus motivational interviewing and cognitive-behaviour therapy (MI/CBT). The results showed that those patients who completed all sessions of the intervention program were 20 percent more likely to achieve abstinence or significant smoking reduction.

Quitting Street Drugs

Another study² conducted at CMHS investigated whether an intervention program of motivational interviewing and cognitive-behaviour therapy was more effective than routine treatment in reducing cannabis, alcohol and/or amphetamine use. Similar to the smoking study, 160 substance using schizophrenia patients were divided into two groups, one of which received the 10-session MI/CBT intervention program.

While some temporary benefits were noted during participation in the program, there were no differences in terms of frequency of drug use between the treated and untreated groups 12 months after the treatment. These results indicate that MI/CBT alone is ineffective in aiding schizophrenia patients to break addiction to street drugs.

¹Baker A, Richmond R, Haile M, Lewin T, Carr V, Taylor R, Jansons S, Wilhelm K. Randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. American Journal of Psychiatry (in press)

² Baker A, Bucci S, Lewin T, Kay-Lambkin F, Constable P, Carr V. Cognitive-behavioural therapy for substance use disorders in people with psychotic disorders. British Journal of Psychiatry 2006; 188: 439-448.