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Co-Occurring Disorders

Schizophrenia and Addiction

Schizophrenia is a mental illness that often co-occurs with substance use disorder. This can cause a number of social, legal, and medical problems, including complicating the treatment process.

What is schizophrenia?

The National Institute of Mental Health describes schizophrenia as “a serious mental illness that impacts how an individual feels, thinks, and behaves.” A person with schizophrenia may experience a collection of symptoms that can affect their sense of reality. This can have a significant impact on quality of life and can cause distress for the person and their loved ones.

What are the symptoms of schizophrenia?

The main symptoms of schizophrenia fall into three categories: psychotic, negative, and cognitive. We often hear the word “psychotic” misused, but in this case, it includes symptoms like altered perceptions, psychosis, changes to senses (sight, sound, smell, touch, and taste), and a distorted sense of reality. Negative symptoms are things like a loss of motivation and enjoyment in everyday life (like depression). The cognitive category of symptoms includes having difficulty concentrating, trouble continuing activities until their completion, difficulty processing information and making decisions, and problems retaining information. A related disorder called schizoaffective disorder combines many of these issues with symptoms of other mood disorders.

Schizophrenia is commonly diagnosed after an episode of psychosis—where the mind loses its sense of reality. During such an episode, a person’s thoughts and perception of reality are distorted. The person may struggle to differentiate between what is real and what is not, and may experience paranoia or delusions of thought, such as feeling threatened like someone is “out to get them.” They may have hallucinations, like hearing voices or seeing things that are not there.

However, a person with schizophrenia may experience other symptoms before that first episode of psychosis, and therefore before diagnosis. These preliminary symptoms can include changes in mood and social functioning.

Schizophrenia is usually diagnosed in the late teens to twenties for males and early twenties to early thirties for females.

Treatment for schizophrenia includes medication (such as antipsychotics), behavioral therapy (like cognitive behavioral therapy), family support and education, and supported employment and education.

What is substance use disorder?

Substance use disorder (SUD) is another mental disorder characterized by persistent alcohol and/or drug use (sometimes referred to as drug abuse) despite the negative consequences on the person’s life. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) SUD can cause significant impairment, such as health problems, disability, and failure to meet major responsibilities at home, work, or school.

People with mental disorders, such as schizophrenia commonly self-medicate their symptoms with drugs and/or alcohol.

How commonly does addiction occur with schizophrenia?

An article in the American Journal of Psychiatry says that nearly 50 percent of patients with schizophrenia also have a co-occurring substance use disorder. Alcohol and cannabis are the most common substances used by people with schizophrenia.

Researchers Drake et al., state it is not unsurprising that these two mental disorders co-occur. “Undoubtedly, the availability of alcohol and the fact that it is legal contribute to its widespread abuse among people with schizophrenia.”

Do any particular drugs impact dual diagnosis?

According to researchers, the drugs of choice seem to matter with this co-occurrence as schizophrenia most commonly occurs with alcohol use disorder or cannabis use disorder—at a rate of three times the general population.

Researchers have found that the co-occurrence of SUD and schizophrenia is not only seen in patients who have had a long struggle with their schizophrenia, but also early on. Rates of cannabis use disorder are as high as 53 percent in patients experiencing their first psychotic episode. Cannabis use is associated with an earlier onset of schizophrenia and an enhanced risk of relapse.

What are the risk factors for co-occurring schizophrenia and SUD?
Experts suggest a number of risk factors of these comorbid conditions.

  • Stress
  • Environmental stressors such as substance use in vulnerable individuals
  • Substance abuse is likely to cause an earlier onset of schizophrenia
  • Cannabis use in adolescents with certain gene expressions (“high output” catechol O -methyltransferase polymorphism)
  • Self-medication to lessen the effects of antipsychotic medications.

In summary, scientists believe that patients with schizophrenia have a heightened vulnerability to the effect of psychoactive substances and alcohol misuse (sometimes referred to as alcohol abuse) that can lead to adverse consequences.

Workit Health has treatment programs for opioid and alcohol use disorders and some mental health conditions, but does not have a program specifically for schizophrenia.

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