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Co-occurrence of schizophrenia and substance use disorders – diagnosis and management. Guidelines from the Expert Group of the Polish Psychiatric Association. Part II. A review of available guidelines
 
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1
Department of Psychiatry, Medical University of Warsaw
 
2
3rd Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw
 
3
Department of Psychiatry and Adult Psychiatry Clinic, Jagiellonian University Medical College
 
4
Department of Adult Psychiatry, Medical University of Łódź
 
5
Department of Psychiatry, Medical University of Białystok
 
6
Chair and Department of Psychiatry, Medical University of Warsaw
 
7
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
This article provides an overview of international guidelines for the treatment of the cooccurrence of schizophrenia and substance use disorders (dual diagnosis, DD). The authors emphasize that the available guidelines recommend a comprehensive assessment of both disorders and integrated treatment; however, there is a lack of clear recommendations regarding the selection of antipsychotic medications. The choice of pharmacotherapy should take into account the symptom profile, the risk of interactions with psychoactive substances, safety, adverse effects, and adherence to treatment. For patients with low adherence, longacting antipsychotics (LAIs) are recommended, and cariprazine may be beneficial in patients with severe negative symptoms and substance craving. Addiction treatment should proceed in parallel with schizophrenia treatment and include both pharmacotherapy and psychosocial interventions. The integrated model, in which a single therapeutic team provides simultaneous treatment for both disorders, is considered the standard of care. Psychoeducation, motivational interviewing, cognitive-behavioral therapy, family support, and harm reduction programs play a key role. This approach increases treatment retention, improves functioning, and reduces the risk of psychosis relapse and substance use recurrence.
eISSN:2391-5854
ISSN:0033-2674
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