Schizophrenia and Substance Abuse | Treatment for Co-Occurring Disorders | Futures of Palm Beach
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Schizophrenia and Substance Abuse

girl-in-therapy Schizophrenia is one of the most complicated, misunderstood brain disorders. The condition is often associated with psychotic episodes, wild behavior, and bizarre distortions of reality. Because the term “schizophrenia” translates as “split mind,” many people mistake this condition for multiple personality disorder. However, the split mind of schizophrenia actually refers to a dissociation between the individual’s perceptions and the external world. People who suffer from schizophrenia have experiences that conflict with the cultural perception of reality. They may have auditory hallucinations, such as hearing voices, or delusional beliefs, such as the conviction that they are religious prophets or that other people are plotting to harm them. Their physical appearance, behavior and attitudes may seem so bizarre that they cause fear or aversion in others.

Schizophrenia is a debilitating form of mental illness, interfering with the individual’s psychological development, social relationships, work status, and financial stability.

When this disorder co-occurs with substance abuse, the combination increases the risk of negative consequences such as:

  • Homelessness
  • Unemployment
  • Incarceration
  • Hospitalization
  • Accidental injury
  • Self-inflicted injury
  • Addiction
  • Suicide

Schizophrenia is a chronic neurological condition that has no known cure. However, the symptoms of this serious disorder can be treated with a combination of psychotherapy and antipsychotic medication. When substance abuse is a factor, treatment must also involve simultaneous therapy for drug or alcohol addiction.

How Common Is Schizophrenia?

World Health Organization

In the global population, there are about 24 million people who meet the criteria for schizophrenia, according to the World Health Organization. Although the percentage of people who are diagnosed with this disorder is fairly small, those who are diagnosed have the condition throughout their lives. The onset of symptoms usually begins in the teens to early adulthood, and both males and females are affected at equal rates.

American Journal of Psychiatry

According to the American Journal of Psychiatry, alcohol and drug abuse occur in approximately half of the people diagnosed with schizophrenia. People with schizophrenia are three times more likely than the rest of the population to have a substance use disorder. The most common drugs of abuse in schizophrenic individuals are nicotine, alcohol and marijuana.

National Institute of Alcohol Abuse and Alcoholism

The National Institute of Alcohol Abuse and Alcoholism states that alcohol addiction is the most common comorbid condition in people with schizophrenia. But when alcoholism is effectively treated and the individual remains abstinent, many of the negative consequences of the co-occurring disorders are reduced, including:

    • Psychotic symptoms
    • Arrest and imprisonment
    • Psychiatric hospitalization
    • Social instability

Schizophrenics who recover from alcoholism report that they have a better quality of life. They may feel less marginalized socially and may experience fewer breaks with reality. While alcohol and drug abuse can make the course of this brain disorder worse, dual diagnosis treatment can greatly improve personal outcomes.

Types of Schizophrenia

Schizophrenia is a baffling psychiatric illness with a multitude of symptoms. It is sometimes defined as a group of brain disorders rather than a single mental illness. The psychiatric community has distinguished five different types of schizophrenia:

Catatonic

Characterized by abnormal physical movements and episodes of unresponsiveness, combined with a complete withdrawal from reality

Paranoid

Characterized by a deep suspicion or distrust of others and delusional fears about being persecuted or harmed; paranoid schizophrenics can have episodes of intense anger, sometimes accompanied by violence and aggression

Disorganized

Distinguished by persistent psychotic episodes, delusional thinking, a flat emotional affect, and an inability to communicate coherently

Undifferentiated

More than one category of symptoms are present in the same individual

Residual

The individual is no longer actively psychotic, but he or she may retain some of the symptoms of schizophrenia

Many people with schizophrenia express different types of symptoms at different times in their lives. The most common type of schizophrenia, and the type most likely to be affected by drug or alcohol addiction, is paranoid schizophrenia. Because people in this subgroup are higher functioning than individuals with catatonic or disorganized schizophrenia, they are more likely to have access to drugs or alcohol. They may use substance abuse to manage their hostility and fear, especially if they are not being adequately treated for their mental illness.

The Roots of Schizophrenia and Substance Abuse

The origins of schizophrenia are not yet fully understood. Brain scans of individuals with this disorder have neurological abnormalities that may contribute to the psychotic symptoms of schizophrenia. Imbalances in neurotransmitters like dopamine and glutamate also play important roles in this illness. In stressful situations — like the death of a loved one, a transition from home to college, or a major physical illness — schizophrenic symptoms are likely to intensify. During these periods, individuals with schizophrenia have an increased risk of psychotic episodes, high-risk behavior, suicide attempts, and psychiatric hospitalization. Drug and alcohol abuse can be a maladaptive way of coping with stress in schizophrenics who are not receiving psychiatric treatment. The socio-environmental theory of schizophrenia and substance abuse holds that addiction is more common in this population because of the social consequences of this severe mental illness. Because schizophrenics have a higher rate of homelessness, poverty, social marginalization and incarceration, they could be at higher risk of drug or alcohol use. Many of the symptoms of drug abuse or drug withdrawal resemble the symptoms of schizophrenia. Withdrawal from alcohol, cocaine, meth or heroin can cause episodes of delusional thinking and visual or auditory hallucinations, especially in heavy users. During the detox phase, addicts may believe that they are being persecuted by others or pursued by legal authorities, even if there is no rational justification for these beliefs. In order to make a diagnosis of schizophrenia, the treatment team must be able to differentiate between substance-induced psychosis and an organic mental illness. The diagnostic process becomes easier after the patient has been through a period of detox to cleanse the drug from his or her system.

Is Schizophrenia Curable?

Schizophrenia is a chronic disease of the brain. Like drug or alcohol addiction, the potential for a relapse is always there, even after treatment and rehab. However, with consistent therapy, psychiatric medication, and a strong support network, schizophrenic symptoms can be successfully controlled. Therapies used to treat schizophrenia include:

Antipsychotic medications

Medication is the first line of treatment for managing schizophrenic symptoms. Atypical antipsychotic drugs have proven to be successful at controlling the symptoms of psychosis with relatively few side effects. Examples include Abilify (aripiprazole), Clozaril (clozapine), Seroquel (quetiapine) and risperidone (Risperdal).

Psychotherapy

Many schizophrenic patients are distrustful or fearful of psychiatric treatment. Client-centered therapies like motivational interviewing (MI) encourage and empower the client to comply with treatment in order to create a healthier, more satisfying life.

Cognitive behavioral therapy

Cognitive behavioral therapy, or CBT, can help schizophrenic individuals react to their symptoms in constructive, positive ways. CBT, which helps the client identify destructive thought patterns and replace them with positive ones, has also been used effectively in substance abuse treatment.

Life skills classes

Schizophrenia can have a devastating effect on an individual’s personal security, financial stability, and social relationships. Life skills training helps schizophrenic clients acquire the practical skills they need to integrate successfully into the community.

Family counseling

Creating a healthier home environment is one of the primary goals for schizophrenia treatment. Family members should be educated about the illness and supported through the recovery process. If substance abuse is involved, the need for education and counseling is even more acute.

Early recognition and treatment of schizophrenia can improve the individual’s chances of a successful recovery. The University of Maryland Medical Center notes that schizophrenic patients who are treated during their first episode are less likely to require hospitalization in the five years after treatment.

Treatment for Co-Occurring Disorders

The combination of an addictive disorder and schizophrenia puts the individual at a much higher risk for negative outcomes. Integrated dual diagnosis treatment addresses both the substance use disorder and this serious brain disease at the same time, at the same facility. Approaches to treatment target the relationship between schizophrenic symptoms and drug or alcohol abuse through therapies such as:

  • Psychiatric medication
  • Anti-addiction drugs
  • Motivational enhancement therapy
  • Behavioral modification training (cognitive behavioral therapy and dialectical behavior therapy)
  • 12-step recovery programs
  • Peer group counseling
  • Stress reduction therapies (yoga, acupuncture, massage, martial arts)
  • Family support and counseling

In dual diagnosis treatment, psychiatric medication is a key component of recovery. According to the Harvard Review of Psychiatry, the co-occurrence of schizophrenia and substance abuse could be related to deficiencies in the brain’s natural reward circuitry. In order to reinforce certain behaviors, the brain releases the neurotransmitter dopamine, which creates feelings of pleasure and contentment. Drugs and alcohol can also affect dopamine levels in the brain. In schizophrenics, problems with dopamine production may trigger the need to use drugs or alcohol in order to re-establish balance in the brain’s reward system. Atypical antipsychotic drugs like clozapine (Clozaril) may help to correct these neurological deficiencies, decreasing the risk of substance abuse while reducing psychotic symptoms. At Futures of Palm Beach, we integrate a full range of evidence-based therapies to give our dual diagnosis clients the very best shot at recovery. Our spa-like facility in Palm Beach County, FL, provides the ideal atmosphere for rehabilitation. We are committed to helping clients with challenging conditions like schizophrenia avoid the devastating consequences of addiction. For answers to your questions and support in your search for healing, call our toll-free number at any time.

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