Clozapine for Substance-Abusing Schizophrenic Patients

Mr. A, a 43-year-old single white man with a 15-year history of paranoid schizophrenia and cocaine and alcohol abuse, had been hospitalized more than 20 times as a result of psychotic exacerbations concurrent with drug and alcohol abuse. He underwent multiple medication trials without any significant change. Mr. A used alcohol and cocaine intermittently, despite participating in our dual-diagnosis treatment program. Although he was medication compliant, his psychotic symptoms persisted. He was treated with clozapine, and the dose was gradually increased to 550 mg/day at bedtime. Since then, he has had no further hospital admissions. His memory has improved, and he is able to use skills from the drug-relapse classes. He has had no medication side effects, and he reports that he only has occasional psychotic symptoms. Mr. A has not used alcohol or cocaine since starting clozapine treatment, as validated by weekly urine analyses. Moreover, he claims that his cravings for drugs and alcohol have been reduced by clozapine, and when these cravings do occur, they are often easier to manage. Currently, he remains abstinent, and he is psychiatrically stable.