Many schizophrenic patients, who are treated with antipsychotic drug, do not adhere to the pharmacotherpy. Antipsychotic drugs constitute a palliative treatment, and their long-term administration is not secure. Instead of following the pharmacotherapy, some patients tend to consume alcohol and tobacco, and even amphetamines and cannabis. The reason of the patients to not adhere to the pharmacotherapy will be discussed, and the effect of alcohol, tobacco and drugs on the disease outcome will be addressed. Appropriate measures to make the patients to renounce of substances and drugs and to improve the patients’ adherence to the pharmcotherapy will be described. Alterations of classical neurotransmitters in the hippocampus, mesolimbic system and prefrontal cortex will be mentioned. The different compounds of cannabis, tetrahydrocannabidiol (a psychotomimetic) and cannabidiol (exerts antipsychotic actions). The effect of alcohol, tobacco and drugs to worsen the antipsychotic treatment will be pointed out. Appropriate measures to improve the antipsychotic pharmacotherapy and to reduce the consumption of substances and drugs are the administration of long-acting injectable antipsychotic drugs and psychoeducation and cognitive behavioral therapy Some new drugs, for example the cannabis compound cannabidiol that shows antipsychotic properties and ß-varenicline, a nicotinergic cholinergic agonist, might be administered when substance abuse (cannabis, nicotine) occurs.
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