Dual Diagnosis: Schizophrenia And Addiction Treatment Options

Schizophrenia, and other mental health conditions, make treating addiction more difficult. Recovery is possible with proper treatment and medication.

Dual Diagnosis: Schizophrenia And Addiction

Schizophrenia affects millions of people and interferes with their ability to think clearly and manage emotions. Some studies show that nearly half of people with schizophrenia also struggle with drug or alcohol abuse. Nicotine use is also high among schizophrenics, as some figures show a staggering 90% of people with schizophrenia are addicted to cigarettes.

What Is Schizophrenia?

Schizophrenia is a severe mental disorder that changes a person’s feelings, thoughts, and behavior. The condition is chronic, meaning it lasts a long time or is reoccurring (always coming back). While schizophrenia is less common than other mental health conditions, the illness can be debilitating because some symptoms make people seem out of touch with reality.

The symptoms of schizophrenia are generally split into three categories:

  • cognitive
  • positive
  • negative

Cognitive symptoms are related to a person’s thinking and memory, and can be either subtle or severe. These symptoms include trouble paying attention, difficulty understanding information to make decisions, and having problems using information immediately after learning it (also called “working memory”).

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Positive symptoms describe psychotic behaviors usually absent in healthy people. These symptoms are likely the most commonly associated with schizophrenia and include:

  • agitated body movements (movement disorder)
  • delusions
  • hallucinations (seeing or hearing things that aren’t there)
  • unusual ways of thinking (thought disorder)

Negative symptoms refer to normal emotions or behaviors that get confused or disrupted by schizophrenia. These symptoms include limited speaking, problems starting and finishing activities, lack of pleasure in everyday life, and having a “flat affect,” or little emotion expressed in facial expressions or speech.

People suffering from schizophrenia have a tendency to use substances that are affordable and accessible, like alcohol and nicotine (substance found in cigarettes). Cigarette addiction is very common, with research showing nearly half, or as high as 90%, of people with schizophrenia smoke habitually.

Schizophrenia And Cigarette Addiction

Many researchers and scientists believe people suffering from schizophrenia may become addicted to cigarettes as a form of self-medication. In this context, self-medication refers to using a substance to reduce the adverse effects of a mental disorder, like stress, anxiety, and paranoia.

Cigarettes may be effective for self-medication because the nicotine may balance mental impairments, offset psychotic symptoms, and reduce uncomfortable side effects of antipsychotic medications. While there is little evidence, the self-medication theory may explain why so many people suffering from schizophrenia smoke cigarettes.

Research on the link between nicotine and schizophrenia highlight how some brain irregularities may make some people more susceptible to schizophrenia. These same irregularities that may lead to schizophrenia may also increase the rewarding effects of nicotine, and also make it harder to stop.

Some research done in animals show nicotine may improve memory and attention for those suffering from schizophrenia. A medication called clozapine acts similarly to nicotine, and is one medication that may help people reduce or even stop smoking.

The unfortunate truth is people with schizophrenia have higher rates of not only tobacco use, but drug and alcohol use as well. Alcohol Use Disorder (AUD) is another common co-occurring disorder for people with schizophrenia because of both social and biological factors.

Schizophrenia And Alcohol Use Disorders

One of the contributing factors of the prevalence of alcohol use disorders among those suffering from schizophrenia is the simple fact that alcohol is legal and widely accessible. Studies show that a third of people diagnosed with schizophrenia also suffer from AUD, which means they struggle with alcohol dependence and may put themselves or others at risk when they drink.

AUD in people with schizophrenia is 3 times higher than the rest of the general population.

People suffering from schizophrenia and an alcohol use disorder may lead to the following:

  • frequent hospital admissions
  • homelessness
  • hostile behavior
  • increase in positive symptoms (hallucinations, delusions, etc.)
  • lasting physical problems
  • poor perception or insight
  • refusal to take medications
  • social dysfunction
  • suicidal behavior
  • violent behavior

Certain factors that may contribute to an alcohol use disorder in people with schizophrenia include being male, a family history of AUD, and drinking at a young age. Other risk factors for AUD after a diagnosis of schizophrenia include poor education, a history of violent offenses, and having parents who also struggled with alcohol use.

People with schizophrenia may also develop an AUD because they may be particularly susceptible to the harmful effects of alcohol. A person struggling with schizophrenia may show increases in impaired thinking, poor social judgement, and impulse control when they drink even small amounts of alcohol.

While alcohol may be more accessible than other substances, a great number of people with schizophrenia also suffer from drug addiction.

Schizophrenia And Drug Addiction

About half of all people suffering from schizophrenia also suffer from drug addiction, or substance use disorder (SUD). People with schizophrenia are at higher risk of developing a substance use disorder than the population at large. Although it’s difficult to understand why this is the case, it’s crucial to consider the implications because it makes treating schizophrenia (as well as SUD) more difficult.

Drugs of abuse, and symptoms of schizophrenia like hallucinations, affect similar dopamine pathways in a person’s brain. This explains why intoxication from drugs like methamphetamine, cocaine, and marijuana are likely to lead to psychotic episodes for people with schizophrenia. The involvement of similar brain regions between drugs of abuse and schizophrenia may contribute to the cycle of addiction and erratic behavior.

Another contributing factor to high rates of drug addiction among people with schizophrenia is that both disorders may be genetic. While research is sparse and unclear, there may be an overlap in some genes that increase the risk of developing both schizophrenia and addiction.

People with these conditions, or one or the other, are more exposed to life stressors, which can lead to taking more drugs or experiencing a higher rate of psychotic symptoms. Other social factors, like education, poverty, and unemployment may also contribute to the likelihood of a person developing both disorders.

Suffering from both schizophrenia and addiction increases the risk of heavy smoking, alcohol abuse, and drug overdose. For treatment to be effective, people with dual diagnosis must seek treatment for both disorders to avoid worsening each condition.

Treating Schizophrenia And Addiction

Since people suffering from schizophrenia and addiction have a unique and complicated set of problems and issues, the best approach is likely one program that combines mental health and addiction treatment. This may best be served in an inpatient setting, where the person is likely to receive constant care and a variety of treatments.

Although people with dual diagnosis may be more resistant to treatment than people with only one disorder, staying at an inpatient rehab center will likely offer two crucial elements of treatment: medications and behavioral therapy.

While there is little research indicating what medications are effective to treat both schizophrenia and substance abuse, there are medications that can treat each disorder. Co-occurring disorders need simultaneous treatment, and having access to medications can help treat each condition.

Behavioral therapy is perhaps the most effective treatment for dual diagnosis. With behavioral therapy, a person is able to receive treatment for both disorders at the same time. But, more research is still needed to determine the best course of behavioral therapy for comorbid (dual diagnosis) patients.

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Still, there are some promising therapies that have proven effective for treating schizophrenia, and other mental disorders, simultaneously with addiction. Therapies for adults may include:

  • Assertive Community Treatment (ACT)
  • Dialectical Behavioral Therapy (DBT)
  • Exposure Therapy
  • Integrated Group Therapy
  • Therapeutic Communities

Inpatient rehab is likely the best option because a comorbid person will receive 24 hour, around the clock care, access to medications, and a host of behavioral therapies. People suffering from schizophrenia may be violent and hostile, and providing a safe and supportive environment to address both conditions can offer the hope and skills needed to manage each disorder.

Contact a recovery specialist today for more information on treating schizophrenia and addiction.

National Institute on Drug Abuse - Comorbidity: Addiction and Other Mental Illnesses

National Institute of Mental Health - Schizophrenia

ResearchGate - Alcohol Use Disorders in Schizophrenia

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