Schizophrenia and Substance Abuse
By Staff Writer
Approximately 50 percent of individuals with schizophrenia will have a problem with alcoholism or drug abuse at some point in their lives. This rate is three times higher than the average for the general population, which raises questions about how schizophrenia works.
What is it about this illness that makes sufferers so much more likely to abuse drugs or alcohol? And is there anything that family members of a schizophrenic individual can or should do to make sure that their loved one receives all necessary treatments and support.
Schizophrenia Background and Symptoms
The symptoms of schizophrenia are usually categorized as either positive or negative.
These classifications should not be confused with “good” and “bad.” Rather, positive symptoms are attributes of the illness that are not typically shown in people who don’t have the disorder. A negative symptom is an absence of a trait or the lack of an ability that is usually present in normal, healthy people.
To illustrate, positive symptoms of schizophrenia may include the following:
- Delusions, including paranoia, delusions of grandeur, or false beliefs about the body
- Hallucinations -- often auditory, but they may involve all or any of the senses
- Disordered or disorganized thinking
- Thoughts that don’t follow one another in a logical way
- Incoherent speech
- Catatonia
Meanwhile, the following would fall into the “negative symptoms” category:
- Alogia, or an inability to speak fluently or productively
- Blocked thoughts, including the inability to answer simple questions
- Inability to pick up on social cues or body language
- Narrowing of emotional range or inability to express emotions
- Lack of desire to interact or form relationships with others
- Lack of motivation
The causes of schizophrenia are can be difficult to pinpoint, and they can differ dramatically from person to person. However, most causes of schizophrenia fall into one of the following three categories:
- Genetic – Studies on twins have shown that there is a high level of heritability for schizophrenia. Most likely, the genetic underpinnings of the illness are not tied to a single gene, but come from a combination of inherited factors.
- Prenatal – Curiously, it has been found that schizophrenics are much more likely to have birthdays during the winter or spring months. This has not yet been explained. Also, there’s evidence that prenatal infection is associated with a higher risk of schizophrenia later in life.
- Social – Childhood abuse, poverty, unemployment, poor housing conditions, racial discrimination, migration and family dysfunction are all associated with higher rates of schizophrenia. In another as-yet-unexplained finding, it has been shown that people who live in urban environments are more likely to have the illness.
Substance Abuse to Deal with Symptoms
One theory to explain the link between schizophrenia and substance abuse is that schizophrenic individuals use substances to reduce positive symptoms and to stimulate the inadequate areas of functioning that lead to negative symptoms.
Studies show that schizophrenics suffer from something called “reward deficiency syndrome,” in which the individual’s brain circuitry prevents the functioning of the neural circuits responsible for pleasure. Because this malfunctioning tends to involve a shortage of the neurotransmitter dopamine, a schizophrenic person may use dopamine-stimulating substances such as alcohol, cocaine and marijuana to achieve a rare sense of well-being.
Meanwhile, the same drugs may be used to calm the delusions, hallucinations and disordered thoughts that make up the positive symptoms of schizophrenia. Some individuals may find that drinking or drugging themselves into a stupor is the only escape from the unpleasant effects of their illness.
Schizophrenia and Violence?
Over recent decades, there has been a common perception that psychotic illnesses such as schizophrenia have a tendency to lead to violence. And indeed it is true that schizophrenics are statistically more likely to commit violent acts than are people without the illness.
However, a U.K.-based study that was published in 2009 casts new light on this issue. This research showed that people with schizophrenia are not inherently more likely to commit violent acts; rather, their excessive risk of violence appears to be associated with their substance abuse.
In other words, a schizophrenic person who does not use alcohol or drugs is just as likely as any normal, mentally stable person to commit violence. However, when a schizophrenic person does use drugs or alcohol, the risk of violence goes up.
The Importance of Dual Diagnosis and Family Involvement
The most tragic cases of schizophrenia involve substance abusing individuals who have no family support network to ensure that they receive multifaceted care. Particularly when the individual obviously abuses alcohol or other drugs, uninformed health care workers may blame strange behaviors on drunkenness or drug-induced impairment. Meanwhile, some schizophrenics abuse substances in secret, which may result in their alcoholism or addiction going unrecognized and untreated.
As a result, many of these individuals get bounced around between different forms of care, never obtaining the comprehensive treatment that they need. It’s even worse for schizophrenics who commit crimes, as the justice system is unlikely to have sympathy for (or even recognize) the many underlying issues that caused the person to commit the crime.
To make matters even more complicated, schizophrenics also tend to suffer from other types of mental illnesses, including generalized anxiety, panic disorder, social phobia, or depression. Even if both the schizophrenia and the substance abuse are recognized, these other problems often go untreated.
In these cases, it’s important for the family to have a hand in treatment. Family members are often more aware than doctors are of the various problems afflicting their loved one, and by speaking up they can ensure that doctors make a correct dual diagnosis instead of just focusing on a single problem.
There are special plans and treatment programs for dual diagnosis, but ensuring that a person who is suffering from schizophrenia makes it into such a program is often dependent upon the willingness of family members to remain involved in the treatment process.
© 2010