Schizophrenia is a severe mental health disorder that affects just over 1 percent of the American adult population annually, the National Institute of Mental Health (NIMH) publishes. Schizophrenia significantly impacts a person's ability to function in everyday life, as the disorder impacts thought processes, emotional regulation and responsiveness, and perceptions of self and the external environment. Personal relationships may be difficult to maintain, and someone struggling with schizophrenia may have trouble holding down a steady job.
Symptoms of schizophrenia are generally considered to be either "positive," meaning they are found among those struggling with the disorder and not in the general public, and "negative," which are symptoms that people battling schizophrenia are lacking when compared to the general population. Positive symptoms include movement disorders, hallucinations, delusions, and dysfunctional ways of thinking. Negative symptoms include an emotional "flat affect" in tone and facial expression, lack of motivation to start an activity and difficulties sustaining it, trouble feeling pleasure, blunted emotions, and a lack of desire to form interpersonal relationships.
Someone struggling with schizophrenia may also suffer from cognitive symptoms, such as trouble concentrating and paying attention, difficulties with working memory (the ability to use information after learning it), and impaired executive functions that make it difficult to process information and make decisions. NIMH reports that schizophrenic symptoms typically begin between the ages of 16 and 30.
Schizophrenia and Substance Abuse
People who struggle with schizophrenia tend to abuse substances like alcohol at higher rates than the general public, the National Institute on Drug Abuse (NIDA) publishes. The journal Dialogues in Clinical Neuroscience reports that as many as half of those who battle schizophrenia also battle alcohol and/or drug dependence, and close to 70 percent smoke cigarettes.
When someone struggles with both schizophrenia and addiction, the disorders are said to be “co-occurring.” There are many potential contributing factors regarding why these disorders co-occur at such high rates, which may include:
- Overlapping brain regions
- Genetic vulnerabilities
- Environmental factors
Both alcohol abuse and schizophrenia may impact brain chemistry and function, which may make a person who battles a co-occurring mental health disorder more vulnerable to then battle addiction if they introduce mind-altering substances. Areas of the brain that regulate emotions and willpower may be dysfunctional in someone who battles schizophrenia and can make a person more apt to drink to excess as well.
Alcoholism and schizophrenia are also considered to have some amount of heritability, meaning that if a family member struggles with either disorder, it increases the possible risks for its onset. Genetics are thought to play a role in the onset of alcoholism about half the time, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. The other half of the time, environmental aspects are likely involved, such as a chronic high stress, a chaotic and unstable home life, and exposure to trauma.
Alcohol also serve as a method of self-medication for schizophrenic symptoms, and a person may drink in order to try and function more "normally." Alcohol can temporarily dull anxiety and lower inhibitions. Someone who struggles with schizophrenia may have poor impulse control and decision-making abilities, which can make them more likely to participate in activities that can be self-destructive, such as problematic drinking.
Regardless of the reason for co-occurring schizophrenia and alcoholism, a specialized professional treatment program can help to manage both disorders and improve a person's overall quality of life.
Hazards of Co-Occurring Schizophrenia and Alcoholism
Symptoms of both schizophrenia and alcoholism are exacerbated by each other. While alcohol may seem to temporarily provide a little relief to some of the anxiety and social difficulties brought about by schizophrenia, when the alcohol wears off, schizophrenic symptoms are likely worse than they were before. Alcohol can also increase the number and intensity of a person's schizophrenic psychotic symptoms, including delusions and hallucinations. It further impairs decision-making processes and other abilities that are already impaired by schizophrenia.
Movement disorders, such as agitated body movements, are often side effects of schizophrenia, and alcohol can make body control worse and impact motor coordination, increasing the potential for an injury, fall, or accident. Someone under the influence of alcohol is more likely to engage in potentially hazardous behaviors as well, which may be elevated even more when the person also struggles with schizophrenia. Excessive alcohol use can lead to a wide range of health issues, illnesses, instances of violence, and injuries, the Centers for Disease Control and Prevention (CDC) warns, including addiction. NIAAA reports that 6.2 percent of the adult American population battled an alcohol use disorder (AUD) in 2015.
Schizophrenia may contribute to homelessness as well as difficulties with relationships and employment, and alcohol abuse can serve to make these matters worse. Legal and criminal troubles may occur as a result of co-occurring and untreated alcoholism and schizophrenia. Alcohol may also be a contributing factor in heightened aggression, violence, and criminal behaviors, and the National Council on Alcoholism and Drug Dependence (NCADD) publishes that alcohol is a factor in around 40 percent of all violent crimes. When someone also struggles with schizophrenia, the odds for a negative outcome when drinking is elevated.
Drinking alcohol can also interfere with treatment for schizophrenia by hindering the functions of necessary medications. As a central nervous system depressant, alcohol slows down vital life-sustaining functions, and when mixed with other medications, there may be unintended side effects, including the potential for a life-threatening overdose.
Schizophrenic symptoms can also impede treatment for alcoholism. Co-occurring schizophrenia and alcoholism are optimally treated through integrated treatment programs.
Integrated Treatment for Co-Occurring Disorders
Schizophrenia is a serious mental illness that is usually treated with both medications and therapeutic methods. Antipsychotic medications can help to control symptoms, and behavioral therapies can help a person learn healthy ways of coping, important life skills, and how to manage everyday life challenges brought on by schizophrenia.
When someone also struggles with alcohol abuse and/or alcoholism, special considerations will need to be made during treatment to ensure that both disorders are addressed and managed. The disorders can exacerbate each other, so an integrated and simultaneous approach can make sure that symptoms of both are taken into consideration at the same time.
Medical and mental health and substance abuse providers should all work together, setting goals that each professional is working toward together. By sharing information across all platforms, treatment professionals can make sure that each aspect of the care provided complements the overall plan. Some medications that may be used to treat schizophrenia may not be ideal for someone who struggles with substance abuse and addiction, for instance, and they may need to be substituted for different medications for someone who battles alcoholism. A drug screening is often performed prior to beginning a treatment program to ensure that medications used to treat either disorder are going to be optimal.
Not all treatment programs provide co-occurring care, however, and some do not offer integrated treatment models. It is important to find a program that employs highly trained professionals with experience treating schizophrenia and co-occurring disorders. Some facilities may treat only addiction or only mental illness, and not address both at the same time. As symptoms of the two disorders may be difficult to separate from each other, an integrated and simultaneous approach is usually considered ideal, the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes. A truly integrated care plan can help to diminish relapse and provide lifelong skills for recovery.
A rehab program that provides integrated care may offer the following:
- Medical detox: When someone suffers from co-occurring disorders, alcohol withdrawal symptoms may be especially intense. A medical detox program can provide medical and mental health support around the clock while often using medications to help a person become physically stable without alcohol.
- Medications: Medications are an important part of a treatment plan for schizophrenia, and they can also manage alcohol withdrawal symptoms and cravings to minimize relapse.
- Therapy and counseling: Group sessions can teach individuals life skills, coping mechanisms, and relapse prevention strategies while individual sessions focus on specific issues and concerns with the goal of improving a person's overall quality of life. Family therapy and counseling can help family members cope with the disorders as well and improve family relationships.
- Support groups: Specific groups made up of other people struggling with similar circumstances can help to create a healthy peer support network that can aid in sustaining long-term recovery.
- Education: Families and individuals can learn more about each disorder, which can improve recovery and the understanding about what to expect in treatment.
- Aftercare support: Individuals are supported throughout recovery via programs that work to lower relapse rates.
Schizophrenia and alcoholism are best treated at the same time by trained professionals who have experience with co-occurring disorders. Generally speaking, a residential treatment program offers the highest level of support and care for co-occurring disorders. Here, individuals are cared for 24 hours a day, seven days a week, in a secure, stable, and safe environment. Structured programming is planned in a predictable pattern throughout each day. Complementary programs, such as art therapy, equine therapy, yoga, meditation, fitness programs, and nutritional planning, may be included in a residential treatment program.
Outpatient services can be beneficial when symptoms are less severe, and individuals have strong and stable home lives. Partial hospitalization and intensive outpatient programs serve as "in-between" services for people who will benefit from the structure of an intensive program and need to return home each night. Transitional services can also be a great option for people transitioning from a residential treatment program who are not quite ready to return right back into society. These programs provide a safe and sober environment to allow a person time to get ready for their full return into society.
A full assessment is generally performed prior to admission into any treatment program. This can help treatment providers better understand what level and type of program will be optimal to manage co-occurring schizophrenia and alcoholism.