Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

5. Alcohol 81symptoms as schizophrenia but lasting less than 6 months) or schizophreniahave a diagnosis of alcohol abuse or alcohol dependence at some time in theirlives. The high rate of alcohol use disorders in patients with schizophrenia maybe related to biological factors, such as self-medication to alleviate symptoms ofschizophrenia, or side effects of antipsychotic medications; underlying abnormalitiesof dopamine regulation may provide a common basis for the high rateof co-occurrence; or patients with schizophrenia may be particularly vulnerableto the negative effects of substance use due to the impaired thinking andimpaired social judgment that are part of the schizophrenic syndrome, thusincreasing their vulnerability for a substance use disorder. It is critical that thetreatment for schizophrenia and alcohol use disorders be integrated. Thisinvolves multidisciplinary treatment teams that provide outreach and comprehensiveservices. Osher and Kofoed (1989) describe four stages that are effectivewith patients with comorbid schizophrenia and alcohol use disorders: (1)developing a trusting relationship; (2) motivating the patient to manage bothillnesses and pursue recovery goals; (3) providing active treatment that includesdevelopment of skills and supports needed for illness management and recovery;and (4) developing relapse prevention strategies to avoid and minimize theeffects of relapse.Eating DisordersOver the past decades, numerous studies among patients in treatment haveindicated the co-occurrence of eating disorders and substance use disorders.However, these studies are often methodologically limited, and have provided awide range of estimates of eating disorders in patients with substance use disorders,from 2 to 41%. More recently, improved methodological approaches havedetermined that (1) substance use disorders do not have a significantly greaterco-occurrence with eating disorders compared to other psychiatric controls, and(2) although eating disorders are frequently diagnosed among inpatients withsubstance use disorders, they are also frequently diagnosed in other psychiatricinpatients. At this time, there is no strong relationship between eating disordersand substance use disorders, and studies that report strong associations typicallyinvolve patients who have additional psychiatric disorders that frequentlyco-occur with eating disorders and substance use disorders (Dansky, Brewerton,& Kilpatrick, 2000).Personality DisordersThe assumption that alcoholism and personality traits are linked in some fashionhas a long history. Earlier editions of the DSM (DSM-I and DSM-II) classifiedalcoholism along with personality disorders. By 1980, with publication ofDSM-III, substance use disorders (including alcoholism) were understood asentities independent of the personality disorders.