Co-occurrence of schizophrenia and substance use disorders – diagnosis and management. Guidelines of the Expert Group of the Polish Psychiatric Association. Part III. Management in special situations. Polish guidelines for the treatment of patients with dual diagnosis
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Department of Psychiatry, Medical University of Warsaw
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3rd Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw
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Department of Psychiatry and Adult Psychiatry Clinic, Jagiellonian University Medical College
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Department of Adult Psychiatry, Medical University of Łódź
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Department of Psychiatry, Medical University of Białystok
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Chair and Department of Psychiatry, Medical University of Warsaw
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Department and Clinic of Psychiatry, Pomeranian Medical University in Szczecin
Submission date: 2026-07-11
Acceptance date: 2026-08-10
Online publication date: 2026-10-15
Publication date: 2026-10-15
Corresponding author
Agata Szulc
Klinika Psychiatryczna,Wydział Nauk o Zdrowiu,Warszawski Uniwersytet Medyczny
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ABSTRACT
The third part of the guidelines of the Polish Psychiatric Association presents principles for the management of patients with schizophrenia and co-occurring substance use disorder (dual diagnosis). The authors emphasize that effective treatment requires an integrated care model led by a single multidisciplinary team, ensuring continuity of care, assessment of adherence to treatment recommendations, and consideration of psychosocial factors. A key element is relapse prevention through monitoring early warning signs, implementing individualized action plans, appropriate pharmacotherapy (including long-acting antipsychotics for patients with poor adherence), concurrent treatment of substance use disorder, and active family support.
The guidelines also discuss management in specific situations, such as pregnancy, adolescence, advanced age, and comorbid somatic diseases, highlighting the need for individualized therapy and close collaboration among specialists. Treatment effectiveness should be assessed in a multidimensional manner ‒ through control of schizophrenia symptoms, reduction in substance use, and improvement in quality of life and social functioning. The document concludes with a set of practical recommendations covering diagnosis, pharmacotherapy, psychotherapy, safety monitoring, and strategies for harm reduction and relapse prevention.