Skip to main content Accessibility help

Pharmacotherapy in dual diagnosis

  • Ilana B. Crome and Tracey Myton


The prevalence of coexisting substance misuse and psychiatric disorder (dual diagnosis, comorbidity) has increased over the past decade, and the indications are that it will continue to rise. There have simultaneously been unprecedented developments in the pharmacological treatment of alcohol, opiate and nicotine misuse. Here we evaluate the evidence on the use of some of these treatments in dual diagnosis (with psychotic, mood and anxiety disorders). The evidence base is limited by the exclusion of mental illness when pharmacological agents for substance misuse are evaluated and vice versa. We set the available information within the context of the psychosocial management of comorbid substance misuse and mental illness, and the framework for service delivery recommended by UK national policy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Pharmacotherapy in dual diagnosis
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Pharmacotherapy in dual diagnosis
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Pharmacotherapy in dual diagnosis
      Available formats



Hide All
* Abdulrahim, D., Annan, J., Cyster, R. et al (2001) Developing an Integrated Model of Care for Drug Treatment: Promoting Quality, Efficiency and Effectiveness in Drug Misuse Treatment Services. London: National Treatment Agency.
Abou-Saleh, M. T. (2004) Dual diagnosis: management within a psychosocial context. Advances in Psychiatric Treatment, 10, 352360.
Andrews, G. & Jenkins, R. (eds) (1999) Management of Mental Disorders (vols. 1 & 2). London: World Health Organization Collaborating Centres in Mental Health.
* Banerjee, S., Clancy, C. & Crome, I. B. (eds) (2002) Co-existing Problems of Mental Disorder and Substance Misuse (Dual Diagnosis): An Information Manual (2nd edn). London: College Research Unit and Royal College of Psychiatrists.
Besson, J., Aeby, F., Kasas, A. et al (1998) Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study. Alcoholism: Clinical and Experimental Research, 22, 573579.
Best, D., Rawaf, S., Rowley, J. et al (2000) Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents. Drug and Alcohol Dependence, 60, 319321.
Brown, E. S., Nejtek, V. A., Perantie, D. C. et al (2002) Quetiapine in bipolar disorder and cocaine dependence. Bipolar Disorders, 4, 406411.
Buckley, P., Thompson, P. A., Way, L. et al (1994) Substance abuse and clozapine treatment. Journal of Clinical Psychiatry, 55 (suppl. B.), 114116.
Chang, G., Wilkins-Hang, L., Berman, S. A. et al (1999) Brief interventions for alcohol use in pregnancy. A randomised trial. Addiction, 94, 14991508.
Charney, D. A., Paraherakis, A. M. & Gill, K. J. (2000) The treatment of sedative–hypnotic dependence: evaluating clinical predictors of outcome. Journal of Clinical Psychiatry, 61, 190195.
Cheeta, S., Schifano, F., Oyefeso, A. et al (2004) Antidepressant-related deaths and antidepressant prescriptions in England and Wales, 1998–2000. British Journal of Psychiatry, 184, 4147.
Conley, R. R., Kelly, D. L. & Gale, E. A. (1998) Olanzapine in treatment refractory schizophrenic patients with a history of substance misuse. Schizophrenia Research, 33, 95101.
Cook, C. C. H. & Thomson, A. D. (1997) B-complex vitamins in the prophylaxis and treatment of Wernicke–Korsakoff syndrome. British Journal of Hospital Medicine, 57, 461465.
Cornelius, J. R., Salloum, I. M., Haskett, R. F. et al (2000) Fluoxetine versus placebo in depressed alcoholics: a one-year follow-up study. Addictive Behaviour, 25, 307310.
Coulthard, M., Farrell, M., Singleton, N. et al (2002) Tobacco, Alcohol and Drug Use and Mental Health. London: Stationery Office.
* Crawford, V., Clancy, C. & Crome, I. B. (2003) Co-existing problems of mental health and substance misuse (dual diagnosis): a literature review. Drugs: Education, Prevention and Policy, 10 (suppl.), S1S74.
Department of Health (2002) Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. London: Department of Health.
Department of Health (2003) National Alcohol Harm Reduction Strategy: Interim Analytical Report. London: Department of Health.
Drake, R. E., Xie, H., McHugo, G. J. et al (2000) The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophrenia Bulletin, 26, 441449.
Edwards, G. (ed.) (2002) Addiction: Evolution of a Specialist Field. Oxford: Blackwell Publishing.
Evans, K. & Sullivan, J. M. (2000) Dual Diagnosis: Counseling the Mentally Ill Substance Abuser. New York: Guilford.
Fischer, G., Johnson, R. E., Eder, H. et al (2000) Treatment of opioid-dependent pregnant women with buprenorphine. Addiction, 95, 239244.
Frischer, M., Collins, J., Millson, D. et al (2004) Prevalence of comorbid psychiatric illness and substance abuse in primary care in England and Wales between 1993–1998. Journal of Epidemiology and Community Health, in press.
Geerlings, P., Ansoms, C. & Van den Brink, W. (1997) Acamprosate and prevention of relapse in alcoholics. Results of a randomised, placebo-controlled, double-blind study in out-patient alcoholics in the Netherlands, Belgium and Luxembourg. European Addiction Research, 3, 129137.
George, T. P. & Vessicchio, J.C. (2002) Treating tobacco addiction in schizophrenia: where do we go from here? Addiction, 97, 795796.
Gfroerer, J., Penne, M., Pemberton, M. et al (2003) Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort. Drug and Alcohol Dependence, 69, 127135.
Granholm, E., Anthenelli, R., Monteiro, R. et al (2003) Brief integrated outpatient dual-diagnosis treatment reduces psychiatric hospitalizations. American Journal on Addictions, 12, 306313.
Hamilton, S. P., Klimchak, C. & Nunes, E. V. (1998) Treatment of depressed methadone maintenance patients with nefazodone. American Journal on Addictions, 7, 309312.
Hawton, K., Arensman, E., Townsend, E. et al (1998) Deliberate self-harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ, 317, 441447.
Hertzman, M. (2000) Divalproex sodium used to treat concomitant substance abuse and mood disorders. Journal of Substance Abuse Treatment, 18, 371372.
Hunt, G. E., Bergen, J. & Bashir, M. (2002) Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophrenia Research, 54, 253264.
Kiefer, F., Jahn, H., Tarnaske, T. et al (2003) Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism. Archives of General Psychiatry, 60, 9299.
Kranzler, H. R., Burleson, J. A., Korner, P. et al (1995) Placebo-controlled trial of fluoxetine as an adjunction to relapse prevention in alcoholics. American Journal of Psychiatry, 152, 391397.
Levin, F. R., Evans, S. M., Coomaraswammy, S. et al (1998) Flupenthixol treatment for cocaine abusers with schizophrenia: a pilot study. American Journal of Drug and Alcohol Abuse, 24, 343360.
Lingford-Hughes, A., Potokar, J. & Nutt, D. (2002) Treating anxiety complicated by substance misuse. Advances in Psychiatric Treatment, 8, 107116.
Lingford-Hughes, A., Welch, S. & Nutt, D. J. (2004) Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity. Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 18, 293335.
Littrell, K. H., Petty, R. G., Hilligross, N. M. et al (2001) Olanzapine treatment for patients with schizophrenia and substance abuse. Journal of Substance Abuse Treatment, 21, 217221.
Malec, T. S., Malec, E. A. & Dongier, M. (1996) Efficacy of buspirone in alcohol dependence: a review. Alcoholism: Clinical and Experimental Research, 20, 853858.
Mason, B. J., Kocsis, J. H., Ritvo, E. C. et al (1996) A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression. JAMA, 275, 761767.
McGrath, P. J., Nunes, E. V., Stewart, J. W. et al (1996) Imipramine treatment of alcoholics with primary depression. Archives of General Psychiatry, 53, 232240.
Murray, R. M. (1980) Why are the drug companies so disinterested in alcoholism? British Journal of Addiction, 75, 113115.
National Institute for Clinical Excellence (2002) Guidance on the Use of Nicotine Replacement Therapy (NRT) and Bupropion for Smoking Cessation. Technology Appraisal Guidance no. 39. London: NICE.
Nunes, E. V., Quitkin, F. M., Donovan, S. J. et al (1998) Imipramine treatment of opiate-dependent patients with depressive disorders. A placebo-controlled trial. Archives of General Psychiatry, 55, 153160.
Petrakis, I., Carroll, K., Gordon, L. et al (1994) Fluoxetine treatment for dually diagnosed methadone maintained opioid addicts: a pilot study. Journal of Addictive Diseases, 13, 2532
Regier, D. A., Farmer, M. E., Rae, D. S. et al (1990) Comorbidity of mental disorders with alcohol and other drug misuse: results from the Epidemiologic Catchment Area Study. JAMA, 264, 25112518.
Schmitz, J. M., Averill, P., Stotts, A. et al (2001) Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Drug and Alcohol Dependence, 63, 207214.
Schuckit, M., Irwin, M. & Smith, T. L. (1994) One-year incidence rate of major depression and other psychiatric disorders in 239 alcoholic men. Addiction, 89, 441445.
Scottish Executive (2003) Mind the Gaps: Meeting the Needs of People with Co-occurring Substance Misuse and Mental Health Problems. Edinburgh: Scottish Executive.
* Slattery, J., Chick, J., Cochrane, M. et al (2003) Prevention of Relapse in Alcohol Dependence. Health Technology Assessment Report no. 3. Glasgow: Health Technology Board for Scotland.
Stockwell, T., Hodgson, R., Edwards, G. et al (1979) The development of a questionnaire to measure severity of alcohol dependence. British Journal of Addiction to Alcohol and Other Drugs, 74, 7987.
Sullivan, J. T., Skykora, K. & Schneiderman, J. (1989) Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA–Ar). British Journal of Addiction, 84, 13531357.
Tyrer, P. & Weaver, T. (2004) Desperately seeking solutions: the search for appropriate treatment for comorbid substance misuse and psychosis (editorial). Psychiatric Bulletin, 28, 12.
Zimmet, S. V., Strous, R. D. & Burgess, E. S. (2000) Effects of clozapine on substance use in patients with schizophrenia and schizoaffective disorder. Journal of Clinical Psychopharmacology, 20, 9498.

Related content

Powered by UNSILO

Pharmacotherapy in dual diagnosis

  • Ilana B. Crome and Tracey Myton


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.