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Alcohol and Schizophrenia

People who are diagnosed with schizophrenia commonly struggle with distressing symptoms and may turn to alcohol or other substances as a way of self-medication, which is a dangerous coping tool. Learn more about schizophrenia, how alcohol use interacts with symptoms of schizophrenia, and how these co-occurring disorders are treated.

What is Schizophrenia?

Schizophrenia is a mental health disorder, specifically a psychotic disorder, that affects thoughts, behaviors, and emotions.1 There is a very strong genetic component to schizophrenia, involving multiple genes, and therefore this disorder can be passed down from parent to children.3,4 Some other factors may also play a role in the development of schizophrenia, including nutritional deficiencies or being exposed to some viruses in utero, as well as increased stress, puberty, and changes in chemicals in the brain.3,5 Males are usually diagnosed in their late teens or early 20s, while women are diagnosed between their early 20s to early 30s, although mild symptoms may arise years before a diagnosis is made.1,3 Schizophrenia is a chronic and worsening psychotic condition that can be debilitating without treatment.1,3

Symptoms of Schizophrenia

The symptoms of schizophrenia can be divided into three categories: psychotic symptoms, negative symptoms, and cognitive symptoms.3 Psychotic symptoms alter how you think, behave, and perceive things. Negative symptoms affect your ability to function and interact with others. Cognitive symptoms impact your ability to take in and recall information and focus.3 Symptoms of schizophrenia include:1,2,4,6

  • Delusions, or irrational beliefs such as paranoia or believing that someone is monitoring their thoughts.
  • Hallucinations (seeing or hearing things that are not there).
  • Disorganized, incoherent, or rambling speech.
  • Catatonia (repetitive or purposeless movements).
  • Loss of interest or enjoyment in activities or hobbies.
  • Communicating less.
  • Behaving in a disorganized, inappropriate, or bizarre manner.
  • Lessened emotional expression or flat tone of voice.
  • Lack of motivation towards goal-directed activity.
  • Strange thought patterns.
  • Difficulty paying attention.
  • Trouble remembering things.
  • Indecision.
  • Withdrawing from friends and family.
  • Abnormal sleep-wake cycles.
  • Feelings of depersonalization (feeling detached from self) and derealization (feeling detached from surroundings or reality).
  • Lack of insight into having an illness.
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 Schizophrenia and Alcoholism

People who misuse alcohol to the extent that they cannot control their alcohol consumption, despite the negative consequences may be diagnosed with an Alcohol Use Disorder (AUD).2  When an alcohol use disorder and a mental health disorder are present, it is commonly referred to as co-occurring disorders or dual diagnosis.7,8 People who are diagnosed with schizophrenia are more likely to develop an alcohol use disorder or other substance use disorders.2,4 Nearly 25% of people with schizophrenia will develop AUD at some point in their life.4

There are some shared genetic risk factors between the two diseases, although not everyone with one condition will develop the other.4 Since the symptoms of schizophrenia can be highly distressing, alcohol may be used as a means of self-medication.4 Alcohol might be used in an effort to reduce symptoms, lessen side effects of medications, or simply as an escape from their reality.4,5 However, since schizophrenia can impair judgment, thinking, and impulse control, it can also make people with the disorder more likely to develop an alcohol use disorder.6

Does Alcohol Make Schizophrenia Worse?

While alcohol can’t cause schizophrenia directly, it can influence the progression of the disease and vice versa.6 The symptoms of either disorder can exacerbate the other, and may lead to worse outcomes for both disorders.4  When people with schizophrenia use alcohol to self-medicate, it can actually make symptoms worse.4,5 Alcohol can lead to exacerbation of schizophrenia symptoms, including:2,4,5,6,8

  • Aggressive or violent behavior.
  • Depression.
  • Difficulty maintaining employment
  • Greater risk of suicide.
  • Impaired ability to think clearly and make decisions.
  • Increased impulsiveness.
  • Increased risk of homelessness, hospitalization, and legal issues.
  • Not attending treatment.
  • Non-compliance with medication.
  • Worsening hallucinations and delusions.

Treating Co-Occurring Schizophrenia and Alcohol Use Disorder

It is important to seek medical treatment when you have a co-occurring disorder, not just because alcohol withdrawal can be dangerous, but also to monitor your mental health disorder as you begin your journey to recovery.4,9 

When looking for a treatment facility, finding one that is capable of providing specialized treatment for co-occurring disorders is essential.4 This will allow staff to treat the alcohol use disorder in a way that also addresses the schizophrenia in every step of the treatment process.4 (pe3, e7) Integrated treatment for co-occurring disorders, such as alcohol use disorder and schizophrenia, can take place in a variety of settings including:7,8,9

  • Medically assisted detox. A period of supervised alcohol detox is often the first part of treatment or rehabilitation for AUD. It involves a set of interventions, which often includes medication, that is designed to help you stop drinking and safely withdraw from alcohol. In addition to keeping you stable throughout withdrawal; detox programs help prepare you for additional treatment for AUD.10
  • Inpatient treatment: You may opt to participate in an inpatient treatment program upon completing detox. These programs offer 24/7 care and can last for a few weeks to a few months, as needed. You will learn skills for remaining sober and address any co-occurring issues you may have.
  • Outpatient treatment: You may engage in psychotherapy, medication treatment, and substance abuse treatment on an outpatient basis. You may take part in a program that you attend daily, or once or twice a week.

Therapy and medication commonly play a large role in integrated treatment of co-occurring disorders.4,7 There are therapies such as cognitive behavioral therapy, behavioral skills training, motivational enhancement therapy, and contingency management that have been shown to be effective at treating co-occurring substance use disorders and schizophrenia.3,4 Medications are another important aspect of treatment, and there are many anti-psychotic medications that can be used to manage symptoms of schizophrenia, while some medications used to manage alcohol use disorder can reduce symptoms of schizophrenia as well.3,4

Seeking medical help is an important step on the journey to recovery, especially when diagnosed with a co-occurring disorder such as schizophrenia.3 Withdrawal from alcohol can be dangerous, and many schizophrenia medications require monitoring for effectiveness and potential side-effects.3 Since not all facilities are capable of treating people with co-occurring disorders, it is essential to find a facility that is qualified to provide integrated care for people with co-occurring disorders.

For more information about integrated treatment and how to find the right facility for you, contact us here.

Sources

  1. National Institute of Mental Health. (n.d.). Schizophrenia.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. National Institute of Mental Health. (2020, May). Schizophrenia.
  4. Archibald, L., Brunette, M.F., Wallin, D.J., & Green, A.I. (2019). Alcohol use disorder and schizophrenia or schizoaffective disorder. Alcohol research: Current reviews, 40(1), e1-e9.
  5. Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in clinical neuroscience, 8(1), 37-43.
  6. Drake, R.E., & Mueser, K.T. (2002). Co-occurring alcohol use disorder and schizophrenia. Alcohol research & health, 26(2), 99-102.
  7. National Alliance on Mental Illness. (2020, May). Substance use disorders.
  8. Substance Abuse and Mental Health Services Administration. (2021). Substance use disorder treatment for people with co-occurring disorders, advisory.
  9. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (3rd edition).
  10. Substance Abuse and Mental Health Services Administration. (2019, October). Treatment options: Types of treatment.