Schizophrenia and Addiction

Schizophrenia is a serious, complex, and debilitating mental illness that affects a little more than 1 percent of the American adult population in a given year, per the National Institute on Mental Health (NIMH). Schizophrenia disrupts thought patterns, which in turn affect behaviors, relationships, and the ability to complete everyday tasks. Schizophrenia can cause a person to have unstable moods, actions, and even seem to lose touch with reality and suffer from psychosis.

Generally, symptoms become noticeable between the ages of 16 and 30, NIMH reports. Schizophrenia symptoms generally fall into two main categories: positive symptoms, which are indicative of the disorder and not present in the general population, and negative symptoms, which are things most people do and are lacking in someone with schizophrenia.

Positive symptoms:

• Dysfunctional thought patterns like disorganized thinking
• Hallucinations (seeing or hearing things that aren’t there)
• Delusions (irrational beliefs despite contradictory evidence)
• Movement disorders, such as agitated movements or catatonia

Negative symptoms

• Emotional “flatness” and seeming disconnected
• Trouble feeling pleasure
• Inability to begin activities or complete them
• Monotonous and dull speech patterns

Individuals battling schizophrenia have difficulties concentrating, paying attention, making sound decisions, processing information, and with working memory. Schizophrenia is highly heritable, the National Alliance on Mental Illness (NAMI) states, with genetic and biological factors like brain chemistry and makeup playing a role in its onset. Environmental aspects and the abuse of psychoactive drugs before the brain is fully developed around the age of 25 may also contribute to the development of schizophrenia. Individuals suffering from schizophrenia abuse substances at very high rates as well, contributing to a complex relationship between substance abuse, addiction, and schizophrenia.

Schizophrenia, Smoking, and Other Drugs

According to NIMH, drug and/or alcohol addiction is the most common disorder to co-occur with schizophrenia. Individuals may abuse substances as a way of trying to cope with symptoms of schizophrenia, to “medicate” them with mind-altering substances. When someone uses drugs or alcohol, levels of dopamine are increased, thus heightening pleasure.

The most common substance use disorder (SUD) in someone suffering from schizophrenia is nicotine dependence due to smoking, Psych Central publishes, as individuals with the disorder smoke at rates 2-3 times that of the general population. The National Institute on Drug Abuse (NIDA) reports that drug use, alcohol abuse, and smoking rates are higher among those battling schizophrenia. NIDA also finds that close to 90 percent of individuals with schizophrenia in clinical samples were smokers. Smoking may seem to temporarily relieve some of the problems with learning and memory related to schizophrenia, thus decreasing some of the cognitive deficits as well as increasing levels of dopamine and happiness, the journal Psychiatria Danubina publishes.

Cannabis and alcohol use disorders are also common in individuals battling schizophrenia. The American Journal of Psychiatry (AJP) reports that co-occurring substance use disorders are present in about half of those suffering from schizophrenia, most often involving alcohol or cannabis. Cannabis and schizophrenia have a complex relationship in that it has been postulated that cannabis use can actually lead to psychotic symptoms and potentially cause schizophrenia itself. THC, the active ingredient in cannabis and marijuana, activates cannabinoid receptors in the brain, causing mind-altering effects on perceptions, thoughts, and feelings, and interfering with working memory and cognitive executive functions. Introducing cannabis, especially at a young age, may then interfere with the brain’s formation, potentially cause schizophrenic symptoms, and possibly lead to the onset of the disorder, Psych Central reports. It is likely that cannabis merely speeds up the process in someone who is already predisposed to schizophrenia.

Increased Risk Factors for Addiction with Schizophrenia

Self-medication is often thought to be one of the main reasons someone suffering from a mental illness such as schizophrenia may turn to drugs or alcohol. Mind-altering substances can make someone feel better for a short period of time and possibly even improve symptoms temporarily. Similar parts of the brain may be involved in both the onset of mental illness and the vulnerability for someone to develop addiction. Some of the parts of the brain affected by schizophrenia that manage impulse control, decision-making, and a propensity for risk-taking behaviors may make someone more prone to abuse substances. Both addiction and schizophrenia are considered to have a genetic link, with individuals who have a family history of these disorders having a higher risk of developing them.

Repeated substance abuse damages pathways in the brain, which can cause a person to become dependent on drugs and/or alcohol and potentially lose control over their substance use. Addiction is highly detrimental to a person’s life, impacting them socially, economically, personally, mentally, and physically.

When addiction is coupled with a significant mental illness like schizophrenia, these issues may be compounded. Psychiatric Times reports the following potential complications of a co-occurring SUD and schizophrenia:

• More hospitalizations and for a longer time: Schizophrenic symptoms are exacerbated and made worse by drug use.
• Difficulties with medications: Both noncompliance and interference of the substances abused on the effectiveness of the medications. Nicotine, for example, interferes with the response to antipsychotic medications, causing an individual to need higher doses, Psych Central
• More need for crisis services: This can add to the cost of care.
• Difficulties retaining housing: Individuals may be unable to consistently keep up with their commitments, and interpersonal relationships may be difficult to maintain.
• Legal problems: Addiction and mental illness may lead to decisions or actions that may be criminal or illegal.
• Unemployment and poor money management: Finances suffer as a result of a drug habit as well as poor decision-making abilities.
• Less motivation to seek and continue with treatment programs: Traditional programs may be less effective in the case of co-occurring disorders. Specialized care is recommended.

Increased medical problems and the risk for developing an infectious disease, heart disease, or hepatitis are heightened by chronic substance abuse, as is the potential for being involved in an accident or being the victim of trauma. Episodes of violence, self-harm, and suicidal behaviors may also increase with co-occurring schizophrenia and addiction. Suicide rates for schizophrenia are high, with individuals suffering from the disorder having a lifetime risk of 5-10 percent, the Journal of Psychopharmacology publishes. Adding substance abuse and dependence to the mix only heightens the risk factors.

Specialized Treatment for Addiction and Schizophrenia

Schizophrenia is considered a lifetime disorder, and addiction is a chronic brain disease; however, symptoms can be managed on a long-term basis with the right kind of treatment. Generally speaking, integrated treatment models that employ substance abuse, medical, and mental health professionals as part of a team to treat both addiction and schizophrenia together are considered the best options. Medical interventions and antipsychotic medications can help to effectively manage schizophrenic symptoms.

In the case of co-occurring substance dependence, individuals may need to first process the drugs (or alcohol) from the body through medical detox. Anxiety, depression, mood swings, and even potentially life-threatening physical side effects can all accompany drug withdrawal once a physical drug dependence has been established through regular substance abuse. Schizophrenia only serves to make these symptoms more extreme. Drug withdrawal symptoms can be significant. Especially when a serious mental illness like schizophrenia is also present, medical detox can provide the safest and smoothest route toward becoming sober.

In addition to medications, combined therapy methods that help to holistically work through symptoms and psychosis are also proving useful, as The New York Times reports on recent studies showing the benefits of lower doses of medications coupled with family support, education, and one-on-one therapy sessions. Therapeutic methods can help individuals to both accept themselves and recognize the need to change negative thoughts and behaviors. Individuals also battling addiction are taught to recognize potential triggers for relapse. In treatment, clients learn stress coping mechanisms, better communication skills, and how to regulate their emotions.

Treatment models that continually assess progress and make necessary changes to grow with the individual are necessary. As treatment needs change, so should the level of care provided.

Residential, or inpatient, treatment provides the most comprehensive level of care for individuals battling co-occurring schizophrenia and addiction. After a period of time in a residential program, individuals may move into a transitional living environment before becoming fully integrated back into society. This can provide time for healthy habits to become more fixed, as individuals continue to receive the therapeutic support needed to prevent relapse and progress in recovery. Support groups that cater to individuals suffering from co-occurring disorders can be an important source of support throughout treatment and long into recovery.

Both schizophrenia and addiction are complex disorders. As a result, treatment of these co-occurring disorders requires a specialized level of care. With this degree of treatment expertise, clients can effectively achieve recovery from both disorders.