Background. According to the self-medication hypothesis, schizophrenia patients would abuse psychoactive substances to get a relief from their negative symptoms. Studies testing the self-medication hypothesis in dual diagnosis (DD) schizophrenia have not been conclusive, with some studies showing that DD patients experience fewer negative symptoms, whereas other studies have failed to detect such differences. One potential confounding factor for this discrepancy lies in the diverse scales used to evaluate the negative symptoms. A systematic quantitative review of the literature using computerized search engines has been undertaken.
Method. Studies were retained in the analysis if: (i) they assessed negative symptoms using the SANS; (ii) groups of schizophrenia patients were divided according to substance use disorders (alcohol, amphetamines, cannabis, cocaine, hallucinogens, heroin and phencyclidine).
Results. Attainable published studies were screened. According to our inclusion criteria, 18 possible studies emerged. Data from 11 studies were available for mathematical analysis. A moderate effect size (total n=1135, 451 DD, 684 single diagnosis, adjusted Hedges' g=–0·470, p=0·00001) was obtained, within a random-effect model, suggesting that DD patients experience fewer negative symptoms. Groups did not differ in age, sex, and positive/general psychopathology.
Conclusions. Using narrow criteria (e.g. SANS), the results of this meta-analysis show that schizophrenia patients with a substance use disorder experience fewer negative symptoms than abstinent schizophrenia patients. As such, these results suggest either that substance abuse relieves the negative symptoms of schizophrenia or that the patients with fewer negative symptoms would be more prone to substance use disorders.