Substance use, especially alcoholism, has been recognized as a significant problem in schizophrenic patients, though only a few studies on the effects of pharmacotherapy in these patients have been conducted so far. The thioxanthene neuroleptic flupenthixol, which can be given intramuscularly (i.m.) for improving compliance, has been studied as a possible anti-craving drug both in animal models of alcoholism and some clinical studies. Pilot studies suggest that comorbid schizophrenics with substance use may benefit from treatment with flupenthixol. Efficacy of flupenthixol (10–60 mg i.m.) in reducing alcohol consumption of dual diagnosis patients was studied in an open 6-month clinical trial in 27 schizophrenics with comorbid alcoholism. Twenty-one patients entered the intention-to-treat analysis. Fourteen subjects were completers, 13 dropped out. Six patients completely abstained from alcohol during treatment. Alcohol consumption was significantly reduced compared to baseline (4 weeks before treatment as measured by timeline follow-back interview). In general, while patients showed a marked improvement concerning alcohol consumption, only a slight improvement in psychopathology was recorded. Overall tolerability was good. These data indicate a probable beneficial effect of flupenthixol in schizophrenic patients with comorbid alcoholism. Although the efficacy of flupenthixol as an anti-craving drug in dual diagnosis patients has to be explored in further studies, the drug may be considered a promising medication for these patients.

The possible effects of acute and long-term treatment of the antidipsotropic agent acamprosate on psychomotor performance and driving ability were studied in a prospective open clinical trial involving 5 alcoholic patients without any clinical evidence for cognitive impairement. Acamprosate 1995 mg/day was given for 6 months for relapse prevention with all patients being abstinent throughout the study. No side effects were reported during treatment. Psychomotor performance and driving ability were assessed using the ART 90, a standardized and computerized neuropsychological test battery. A number of relevant subtests measuring peripheral vision, split attention, sensomotoric function, reaction time, stress resistance and the capacity to integrate information was used at study entry, 6 weeks and 6 months after onset of treatment. While in two subtests a moderate improvement in psychomotor performance was found, in most subtests no differences compared to baseline could be shown. The results of this pilot study do not indicate any impairment of psychomotor performance by acamprosate.