In a review of 41 studies of dual diagnosis patients, cannabis was the most commonly abused substance, and aripiprazole was the most frequently used antipsychotic, particularly in long-acting injectable form.
Psychiatrists treating dual diagnosis, addiction medicine providers
Cannabis was the most abused substance in dual diagnosis
What the researchers found
Across 41 studies, most dual diagnosis patients were male with schizophrenia, and cannabis was the most abused substance followed by alcohol. Aripiprazole (oral and long-acting) was the most commonly used second-generation antipsychotic, followed by risperidone, clozapine, olanzapine, and quetiapine.
Why it matters
Dual diagnosis is common but undertreated. Knowing which antipsychotics have been studied and which substances are most prevalent helps clinicians make informed treatment decisions for these complex patients.
The numbers in context
41 articles reviewed; cannabis most common substance; aripiprazole most used SGA; long-acting formulations increasingly studied
How the study worked
Literature search of PubMed and Scopus for studies of second-generation antipsychotics in patients with co-occurring psychotic disorders and substance use disorders, without time restrictions.
What this study cannot tell us
Review of heterogeneous studies with varying methodologies. Most studies were not specifically designed to compare antipsychotics head-to-head in dual diagnosis patients.
How to read the evidence
Systematic review of 41 studies, but heterogeneous study designs and lack of head-to-head comparisons limit definitive treatment recommendations.
When this study was published
Published in 2022
The bigger picture
The high prevalence of cannabis as the primary substance in dual diagnosis highlights the need for treatments that address both psychosis and cannabis use simultaneously, rather than treating each in isolation.
Questions still open
- Which antipsychotic is most effective at reducing both psychotic symptoms and cannabis use? Would long-acting injectable antipsychotics improve treatment adherence in this population?
Common questions
What is the best antipsychotic for people who use cannabis and have psychosis?
Why is cannabis the most common substance in dual diagnosis?
Read the original research
Atypical Antipsychotic Drugs in Dual Disorders: Current Evidence for Clinical Practice.
Current pharmaceutical design, 28(27), 2241-2259
Citation
Martinotti, Giovanni; Chiappini, Stefania; Mosca, Alessio; Miuli, Andrea; Santovito, Maria Chiara; Pettorruso, Mauro; Skryabin, Valentin; Sensi, Stefano L; Giannantonio, Massimo Di. (2022). Atypical Antipsychotic Drugs in Dual Disorders: Current Evidence for Clinical Practice.. Current pharmaceutical design, 28(27), 2241-2259. https://doi.org/10.2174/1381612828666220623092853
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