The most common addictions in schizophrenia include tobacco, cannabis, alcohol, stimulants/recreational drugs, and gambling. This review discusses the multifactorial risk factors for addictions in people with schizophrenia. Several hypotheses have been proposed to explain addiction comorbidity in schizophrenia, and potential biomarkers conferring addiction risk in patients have been identified (e.g., catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF), v-akt murine thymoma viral oncogene homolog 1 (AKT1), cortical inhibition, working memory). Neurotransmitter systems including dopaminergic, glutamatergic, and GABAergic pathways are associated with the pathophysiology of both schizophrenia and addictions. Developing effective treatments for schizophrenia and comorbid addictions is warranted and should involve further studies of neurobiological underpinnings of addiction risk in schizophrenia.
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