The treatment of schizophrenia can be dramatically affected by substance abuse. As many as 50 percent of those diagnosed with schizophrenia also have a co-occurring substance use disorder.

Drug use may mimic symptoms of schizophrenia even in a person without the disorder. For this reason, drug abuse should always be addressed before assessing and treating symptoms of schizophrenia.

Drug Abuse as a Hindrance to Schizophrenia Treatment

The treatment of schizophrenia can be dramatically affected by substance abuse. Unfortunately, in many cases, schizophrenia and substance abuse go hand-in-hand. The use of drugs during treatment is highly likely to reduce the effectiveness of treatment. Another hindrance is the fact that those with substance use disorders often fail to meet their treatment responsibilities. For a person with schizophrenia, this may mean forgetting medications or discontinuing their use altogether.

Effects of Substance Abuse on Schizophrenia Symptoms

Before abstinence from using drugs, a person may not be properly diagnosed. In these cases, their symptoms of schizophrenia may be assumed to be due to drug use rather than the disorder. Furthermore, some drugs may intensify the symptoms of schizophrenia, making them more severe.

Schizophrenia and Alcohol

Alcohol is one of the most frequently used substances by those with schizophrenia. However, alcohol use has been shown to be a clear predictor of violence and suicide by people with schizophrenia. Furthermore, some schizophrenia symptoms may be worsened by alcohol use, particularly if alcohol is used in excess and results in withdrawal. During withdrawal from alcohol, some quasi-psychotic symptoms may be experienced even by people without a history of schizophrenia. For those with schizophrenia, the resulting psychosis may be more intense than previous episodes.

Schizophrenia and Marijuana

Marijuana, like alcohol, is one of the top substances used by those with schizophrenia. Marijuana and schizophrenia may be especially concerning to mix, as the use of marijuana has been associated with earlier age of symptom onset. The mild psychedelic effect of marijuana may also exacerbate the psychosis of schizophrenia. Additionally, marijuana may reduce the efficacy of medications taken to manage schizophrenia.

Schizophrenia and Stimulants

Schizophrenia is highly likely to be worsened by the use of stimulants. These drugs intensify psychotic symptoms and may increase feelings of depersonalization. Stimulant drugs can even trigger the onset of psychosis.

Schizophrenia and Smoking

As smoking cigarettes are typically considered unhealthy, some may be surprised to hear that nicotine has been shown in some cases to improve symptoms of schizophrenia. However, the lengthy list of health risks caused by smoking cigarettes still exist and need to be taken into consideration.

Statistics on Schizophrenia and Drug Abuse

As many as 50 percent of those diagnosed with schizophrenia also have a co-occurring substance use disorder. In addition to intensifying the actual symptoms of schizophrenia, those with a co-occurring substance use disorder are more likely to be hospitalized, become violent, become homeless and have poor medication adherence. The co-occurring use of alcohol and other drugs adds to the already sizable financial burdens for those with schizophrenia. While substance use is very common for those who diagnosed with schizophrenia, it is also very common among those experiencing their first episode of psychosis.

Drug Abuse as a Cause of Schizophrenia

There are numerous stories of people using various drugs and entering a permanent state of psychosis or using in their youth and being diagnosed with schizophrenia when they’re older. But, can drugs cause schizophrenia? The simple answer is no. While there is no evidence that drug abuse can directly cause schizophrenia, it certainly can be a triggering factor. Using drugs can cause a person’s first active psychosis to occur at an earlier age and, depending on the drug used, it can trigger the first episode at the time of use.

Treating Schizophrenia and Co-Occurring Substance Use Disorders

Medication management is often considered the top choice in treatments for schizophrenia. However, when additional disorders, such as a substance use disorder, are present, it is important to include some form of treatment for the co-occurring disorder as well.

  • Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) may be used to assist the patient in understanding their thoughts, feelings and behaviors as they relate to their substance use. The goal is to change faulty thinking patterns that may result in substance use. Furthermore, beliefs about one’s diagnosis of schizophrenia can be challenged to reduce feelings of hopelessness that may contribute to substance use.
  • Motivational Interviewing: The goal of motivational interviewing is to assist a person in identifying the benefits they will receive from change. Creating the motivation to change in individuals with co-occurring substance use and schizophrenia can improve treatment compliance and engagement.
  • Contingency Management: Contingency management can be used to provide incentives for treatment compliance. For people who have co-occurring substance abuse and schizophrenia, this may include incentivizing abstinence from drug use as well as adherence to antipsychotic medications.

Co-occurring schizophrenia and substance use disorder can be difficult to deal with. Fortunately, with the right treatment, it’s possible to manage symptoms and live a fulfilling life. If you or a loved one struggles with addiction and a co-occurring disorder, The Recovery Village can help. Reach out to a representative today for more information.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Denise-Marie Griswold, LCAS
Denise-Marie Griswold is a Licensed Clinical Addictions Specialist. She earned her Master's Degree in Substance Abuse and Clinical Counseling from East Carolina University in 2014. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.