Abstract & Introduction

The prevalence of cocaine abuse among patients with schizophrenia has risen dramatically over the past decade, with some comorbidity estimates greater than 40%. Studies show that cocaine use blocks both dopamine presynaptic and serotonin reuptake, while cocaine abstinence has been hypothesized to cause dopamine depletion. We postulate that, because dopamine and serotonin both mediate schizophrenia symptoms and underlie the reinforcing effects of cocaine, the use of cocaine among individuals with schizophrenia may serve a self-medicating function, or rather, may serve to relieve their negative symptoms and feelings of dysphoria. We propose that there are existing treatments for the alleviation of negative symptoms, which may provide a novel treatment for patients with comorbid schizophrenia and cocaine abuse.

The prevalence of cocaine abuse among patients with schizophrenia has risen dramatically over the past decade, with some comorbidity estimates of more than 40%.[1] Little is known, however, about how cocaine abuse interacts with schizophrenia. Evidence suggests that schizophrenia and cocaine dependence may share some elements of a common pathophysiology, with individuals comorbid for the 2 disorders representing a doubly impaired population. For example, evidence suggests that the use of cocaine among schizophrenic patients is associated with a greater severity of symptomatology, as well as more frequent and prolonged hospitalizations.[2] As a result, there is a need to understand the acute and chronic effects of cocaine on schizophrenic illness and to investigate treatment modalities which treat the core aspects of both disorders. In this article, we will review the current state of knowledge concerning the short- and long-term effects of cocaine use on schizophrenia. In addition, we will examine the possible reasons for cocaine use among schizophrenic patients and review comorbid behavioral and psychopharmacologic treatment strategies.