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In treating patients with schizophrenia and co-occurring SUDs, the second-generation antipsychotics are preferable to the first-generation typical agents, given that typical neuroleptics appear not to decrease substance use in patients with schizophrenia, and there is some evidence that these agents may actually increase substance use in this population (Green 2006). Of the second-generation antipsychotics, clozapine is the most promising medication in patients with schizophrenia and co-occurring SUDs and has been associated with decreased psychosis, increased abstinence, and decreased substance use, including decreased cocaine and nicotine intake; however, there are also data to support the efficacy of risperidone, olanzapine, quetiapine, and aripiprazole for both treating psychotic symptoms and diminishing substance use in this patient population (Green 2006).

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