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P revious research suggests that 16% to 50% of individuals with schizophrenia abuse cocaine (1-3). The prevalence of cocaine abuse in persons with schizophrenia is problematic, considering the debilitating effect that the drug can have on acute symptoms and on illness course. Individuals with schizophrenia and cocaine dependence display more positive symptoms, fewer negative symptoms, and higher rates of extrapyramidal symptoms (EPS) (4,5), which may result from an interaction between dopamine and the psychostimulant properties of cocaine (6).It is widely accepted that aberrations in the dopamine system play a role in the etiology of schizophrenia (7,8) and the maintenance of cocaine addiction via craving (9-11). To examine the clinical impact of these dopamine abnormalities, we compared self-report craving among cocaine addicts and cocaine addicts with schizophrenia. Individuals with schizophrenia and cocaine dependence had significantly more craving, which remained stable over a 72-hour period (12). In a follow-up study, we included a cue-exposure paradigm and found that 97% of the cocaine-dependent persons with schizophrenia were cue-reactive, suggesting the need to target this state in treatment (11).Owing to the rapid increase in dopamine following cocaine use, which can persist for weeks and result in increased craving and depression, researchers have examined dopamine antagonists for treatment of protracted withdrawal. They found Objective: To examine the efficacy of atypical neuroleptics for decreasing craving and drug relapses during protracted withdrawal in individuals dually diagnosed with schizophrenia and cocaine dependence. Method:We conducted a 6-week, open-label pilot study comparing risperidone with typical neuroleptics in a sample of withdrawn cocaine-dependent schizophrenia patients. Results:Preliminary results suggest that individuals treated with risperidone had significantly less cue-elicited craving and substance abuse relapses at study completion. Further, they showed a trend toward a greater reduction in negative and global symptoms of schizophrenia. Clinical Implication · This research suggests that atypical neuroleptic medications, particularly olanzapine, may have anticraving effects and could improve treatment outcomes among the dually diagnosed patients. Conclusion Limitation· This research includes a small sample, an open-label design, and the use of a primarily male veteran population.

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