ABSTRACT
This chapter provides a guide to the treatment of substance abuse in persons with schizophrenia. Treatment of persons with both schizophrenia and substance abuse (SSAs) poses many challenges. First, no cure exists for either disorder. Thus, appropriate treatment goals include abstinence from non-prescribed drugs and alcohol, and stability or remission of the psychiatric disorder. Success, however, is usually measured in the degree of approximation to these goals. Second, both schizophrenia and substance abuse can severely impair adaptive function. In combination, these conditions disable individuals in their ability to fulfill important societal roles such as parent, spouse, wage earner, and citizen. Third, a tradition of separate mental health and substance abuse services restricts the ability of existing treatment resources to meet the challenge. Systems components such as staff training, administrative structure, reimbur-
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sement policies, and treatment philosophies are organized around treating disorders rather than treating people. Finally, the majority of treatment for these disorders takes place on an outpatient basis. This limits the degree of control exercised by treatment personnel over critical variables affecting treatment, such as availability of substances and compliance with treatment recommendations.
