Schizophrenia & Substance Abuse

By Team RehabAid

Last Updated March 22, 2024

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Schizophrenia is a serious mental health condition characterized by disturbances in thought, emotion, and behavior. This includes symptoms such as delusions, hallucinations, unusual thinking patterns, strange speech, and unusual behaviors.

Affecting roughly 1.2% of Americans, schizophrenia can greatly impair a person’s life in areas such as work, relationships, employment, social interactions, and cognition. People with schizophrenia also tend to have co-occurring conditions that not only augment their symptoms, but also make it difficult to properly diagnose them.

According to the American Journal of Psychiatry, 50% of individuals with schizophrenia also struggle with substance abuse. Due to the unpleasant symptoms that accompany this condition, it is no surprise that many individuals turn to substances to cope.

However, hope and treatment are available for people with schizophrenia and/or co-occurring substance use disorder. In this article, we outline what schizophrenia is, how it relates to substance abuse, and what types of treatments are available.

What Is Schizophrenia?

Schizophrenia is a serious mental health condition that affects a person’s thoughts, behaviors, and feelings. Recognized as a set of neurological disorders, schizophrenia causes significant impairment and distress to an individual and their family and friends. Characterized by delusional thoughts, hallucinations, and strange patterns of speech and behavior, schizophrenia is a complex condition that often requires clinical treatment.

Diagnosis

Schizophrenia is usually diagnosed when a person is in their late teen years and into their early thirties. There is also a slight gender difference with this disorder, as males tend to develop schizophrenia earlier than females. Diagnosing schizophrenia often occurs after the first episode of psychosis, which is a hallmark sign of this condition. Other symptoms gradually emerge after this first episode and consist of changes in thoughts, mood, and social functioning.

Types of Schizophrenia

There are various types of schizophrenia, and each is defined by specific sets of signs and symptoms.

Paranoid

Paranoid schizophrenia is the most common type of this disorder. It is marked by a preoccupation with one or more delusions and frequent auditory hallucinations. People with this type of schizophrenia often have delusional beliefs about being threatened, controlled, or persecuted by other people or groups. Individuals with paranoid schizophrenia will also obsess about conspiracy theories, be fearful that they are being tracked or hunted, or they will hear voices that instruct them to harm themselves or others.

Disorganized

Disorganized schizophrenia is exemplified by disorganized behavior and nonsensical speech. This includes odd emotional reactions, chaotic thought patterns, and bizarre speech. Individuals with this condition often find it difficult to look after themselves, hold a job, or interact with others. People with disorganized schizophrenia will also display flat affect and their writing and speech patterns may appear bizarre or incomprehensible.

Catatonic

People with catatonic schizophrenia tend to exhibit excessive movement (known as catatonic excitement) or decreased movement (known as catatonic stupor). Examples include an inability to speak (mutism), a repetition of other people’s words (echolalia), and an imitation of the actions of others (echopraxis). Catatonia can also co-occur with other forms of schizophrenia or mental health conditions such as bipolar disorder.

Residual

Residual schizophrenia is a state where a person no longer displays obvious symptoms of a schizophrenic disorder. While they may have a few lingering symptoms, they no longer suffer from debilitating ones such as delusions, hallucinations, or catatonia. When individuals are diagnosed with this type of schizophrenia, they may exhibit mild signs such as odd beliefs or unusual perceptions.

Undifferentiated

Undifferentiated schizophrenia is a category used for symptoms that cannot be clearly defined. For example, a person may have disorganized speech and occasional hallucinations, but to a lesser degree. People who fall into this category will often not fit the full diagnostic criteria for the other types of schizophrenia, and may have milder symptoms.

Related Conditions

One of the defining characteristics of schizophrenia is psychosis. Therefore, it overlaps with other conditions, such as the ones below:

Schizotypal Personality Disorder

This is a personality disorder that is marked by disturbances in cognition and/or perceptions, eccentric behavior, and difficulties with social interactions and relationships.

Delusional Disorder

Delusional disorder is a condition where a person has delusions for 1 month, but with no other accompanying psychotic symptoms.

Brief Psychotic Disorder

Brief psychotic disorder occurs when symptoms of psychosis are brief, lasting for more than a day but less than a month.

Schizophreniform Disorder

This type of disorder occurs when a person exhibits schizophrenic symptoms for less than 6 months.

Schizoaffective Disorder

Schizoaffective disorder is a condition that is characterized by symptoms of schizophrenia, but with accompanying signs of mood issues, such as mania and/or depression.

Substance- or Medication-Induced Psychotic Disorder

Sometimes psychotic symptoms can be induced or triggered by long-term substance use. This applies especially to alcohol, cannabis, hallucinogenic drugs, or prescription sedatives. Medications like anesthetics, anticonvulsants, and anti-depressants can also induce psychosis.

Co-Occurring Disorders

Like most mental health disorders, schizophrenia also co-occurs with other conditions. Below are some of the most common.

Depression

Many people with schizophrenia are also known to have depression. Some studies indicate that 25% of people with schizophrenia also meet the criteria for depression. These depressive symptoms can occur during all phases of a person’s illness and may be associated with feelings of loss and hopelessness.

Bipolar Disorder

Bipolar disorder and schizophrenia often overlap, as the symptoms are quite similar. Bipolar disorder is marked by extreme changes in mood, energy, and behavior, with individuals often swinging from states of mania to depression. Some individuals with schizophrenia also have co-occurring bipolar disorder, which can complicate diagnoses —especially as conditions like schizoaffective disorder involve a combination of schizophrenic and bipolar symptoms.

Anxiety

Some studies indicate that nearly 40% of individuals with schizophrenia also have a co-occurring anxiety disorder. Other studies show that 23% of people with schizophrenia have obsessive-compulsive disorder (OCD), 15% have panic disorder, and 29% also have post-traumatic stress disorder (PTSD).

Co-occurring anxiety and schizophrenia can be difficult to diagnose, as anxiety also accompanies schizophrenia as a component of schizophrenia (especially during a psychotic episode) or as a side effect of medication. Some individuals also have social anxiety due to an awareness of the stigma associated with their condition.

Signs of Schizophrenia

Signs and symptoms of schizophrenia are grouped into psychotic, negative, and cognitive symptoms.

Psychotic Symptoms

• Altered perceptions (e.g., changes in vision, hearing, smell, touch, and taste)
• Abnormal thinking
• Disorganized speech
• Odd behaviors
• Hallucinations (e.g., hearing voices or seeing things that aren’t there)
• Delusions (e.g., paranoid or irrational fears that others are out to them)

Negative Symptoms

• Loss of motivation
• Disinterest in daily activities
• Social withdrawal
• Difficulty with showing emotions
• Difficulty functioning normally (e.g., being able to work and take care of oneself)
• “Flat affect” or reduced emotional expression via facial expression or voice tone
• Reduced speaking

Cognitive Symptoms

• Problems with attention, concentration, and memory
• Lack of enjoyment in daily activities
• Difficulty processing information to make decisions
• Problems using information immediately after learning it
• Trouble focusing or paying attention

Underlying Risk Factors

While there is no exact cause of schizophrenia, there are several key risk factors. These include:

Brain Structure & Function

Scientists believe that schizophrenia may be caused by differences in brain structure, function, and interactions between brain chemicals (neurotransmitters). For example, research has shown differences in the volumes of specific brain components and in how regions of the brain are connected and work together. Also, brain scans have indicated differences in neurotransmitter levels for glutamate, serotonin, and dopamine in individuals with schizophrenia.

Genetics

Like many mental health conditions, schizophrenia often runs in families. However, this does not mean that it is automatically passed down. Scientists believe that many different genes are involved when it comes to developing schizophrenia, as no single gene is said to cause the condition.

Environmental Factors

Environmental factors are thought to contribute to many mental health conditions, including schizophrenia. These include factors such as trauma, poverty, dysfunctional family patterns, stressful surroundings, and/or exposure to viruses or nutritional deficiencies before birth.

Why Do People With Schizophrenia Abuse Substances?

Many mental health conditions like schizophrenia are accompanied by substance addiction. Additionally, schizophrenia and substance abuse share similar characteristics. These include:

• Unpredictable moods and behaviors
• Withdrawal from social situations
• Delusional beliefs about oneself and others
• Auditory or visual hallucinations
• Disorganized thoughts
• Rapid, pressured speech
• Inappropriate emotional affect
• Poor judgment and high-risk behaviors
• Lack of concentration

Along with these shared characteristics, below are some of the main reasons individuals with schizophrenia turn to substance abuse:

Self-Medication

Individuals who struggle with mental health conditions like schizophrenia often self-medicate by using substances. People with schizophrenia are especially known to abuse alcohol, nicotine, cocaine, and cannabis to ease their symptoms. The problem with using substances to achieve relief is that it not only leads to addiction, but it can also exacerbate symptoms, such as delusions and paranoia.

Genetics & Environment

It is thought that people who develop schizophrenia have a genetic predisposition towards substance abuse. Environmental factors are also suspected to be involved, as most people with schizophrenia have experienced significant trauma in their lives. Other biological risk factors are thought to involve the medications used to treat schizophrenia, as they may produce symptoms that provoke substance abuse or enhance the euphoric effects of drugs and alcohol.

How Does Substance Abuse Affect Schizophrenia?

Another factor when it comes to schizophrenia and substance abuse is how they affect each other. Below are some of the substances that are most commonly abused by individuals with schizophrenia.

Alcohol & Schizophrenia

Alcohol is a readily available substance, making it easy for people with schizophrenia to develop a dependence on it. It is estimated that roughly one-third of people with schizophrenia will develop an addiction to alcohol. While it can be tempting to drink because it relaxes the body, using alcohol frequently and in large amounts can worsen schizophrenic symptoms (such as memory and thinking problems) in the long term. Once alcohol is abused and taken in excess, withdrawal can also exacerbate anxiety and worsen schizophrenic symptoms.

Cocaine & Schizophrenia

Some people use cocaine to cope with the negative symptoms of schizophrenia. However, research shows that patients with schizophrenia who abuse cocaine are at increased risk of suicide and hospitalization. The issue with cocaine and other stimulants is that they can cause schizophrenic symptoms, such as paranoia and psychosis. Stimulants also increase anxiety, which can be difficult for people with co-occurring anxiety and schizophrenia.

Cannabis & Schizophrenia

For reasons that are not yet fully understood, cannabis is a widely abused drug by people with schizophrenia. Some studies have shown that 53% of people who experience their first psychotic episode also qualified for cannabis use disorder.

The problem is that cannabis has been shown to worsen or accelerate psychotic symptoms. While cannabis can provide temporary relief for some individuals, it can also induce auditory hallucinations and lead to paranoia.

Nicotine & Schizophrenia

Nicotine is another highly abused drug by individuals with schizophrenia. Some studies have indicated that 70% of people with schizophrenia also have nicotine dependence. However, people with schizophrenia who also smoke are more likely to experience hallucinations, delusions, and disorganized speech. They are also more likely to require higher dosages of antipsychotic medications.

Schizophrenia & Substance Abuse Stats

• Schizophrenia affects around 3.2 million adults in the U.S. and 20 million people worldwide.
• Schizophrenia affects males earlier (between 18 and 25 years) than females (between 25 and 30 years).
• The National Institute of Mental Health (NIMH) reports that the prevalence of schizophrenia and related psychotic disorders in the U.S. is between 0.25% and 0.64%. This is based on household survey samples, clinical diagnostic interviews, and medical records.
• Approximately 50% of people with schizophrenia have co-occurring mental and/or behavioral health disorders.
• According to the National Institute on Drug Abuse (NIDA), patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population.
• Some studies indicate that up to 50% of patients with schizophrenia exhibit alcohol or drug addiction; more than 70% of those are nicotine dependent.
• It is estimated that around 4.9% of people with schizophrenia die by suicide. This is far greater than the rest of the general population.

Schizophrenia & Substance Abuse Treatment

Treating schizophrenia and substance abuse is possible, but it usually involves multiple forms of therapy, especially as individuals often suffer from related or co-occurring conditions. This is best done using multiple levels of care that begin with detox and continue through to inpatient/residential, outpatient, and aftercare programs.

If you need to seek help, many of these programs are found in rehab facilities or drug treatment centers across the country.

Dual Diagnosis

Centers that offer dual diagnosis treatment are highly recommended, as they are set up to diagnose and treat concurrent mental health conditions and substance abuse. This kind of treatment is especially useful for people who have underlying issues such as schizophrenia, bipolar disorder, anxiety, and depression. Dual diagnosis programs allow clinicians to safely address these conditions while an individual withdraws from alcohol or drugs. Dual diagnosis programs can be found in both inpatient and outpatient clinics.

Key Therapies

Other key treatments that are useful it comes to schizophrenia and substance abuse are:

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) helps individuals change negative cycles of thought and behavior into more positive ones. When it comes to schizophrenia, CBT can help identify and change adverse behaviors as well as paranoid, delusional, and disorganized thought patterns. Clients receiving CBT learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence. CBT also teaches clients how to find solutions to triggers that might encourage drug use.

Dialectical-Behavior Therapy (DBT)

Another effective modality is dialectical-behavior therapy (DBT), a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients better regulate their moods, impulsiveness, and develop healthy coping skills. This kind of therapy is useful for people who have co-occurring conditions, especially those who have psychotic symptoms. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.

Trauma Therapies

Since a history of trauma can cause or exacerbate schizophrenia, trauma treatments such as eye movement desensitization and reprocessing (EMDR) are also effective. Consisting of 8 phases, EMDR is led by a therapist who guides an individual through a series of rapid eye movements to help redirect negative or traumatic memories. This therapy helps individuals overcome the emotional suffering associated with traumatic events.

Family Systems Therapy (FST)

Family Systems Therapy (FST) is a type of psychotherapy that treats the client’s entire household. In this type of approach, schizophrenia and addiction are seen to affect the family unit, so treatment includes goals for everyone involved. This can include educating loved ones about depression and addiction, improving communication, setting realistic boundaries, and learning how to establish an alcohol and drug-free home that supports sobriety.

Medications

Medications are also a useful treatment modality for schizophrenia and substance abuse. They are often used alongside psychotherapies such as cognitive-behavioral therapy. The most common types are:

Typical Antipsychotics

Antipsychotics are the most common medications for individuals with schizophrenia. Older versions (known as “typical antipsychotics”) have been used since the mid-20th century and include:

• Haldol
• Prolixin
• Thorazine
• Loxitane
• Etrafon
• Stelazine

Atypical or 2^nd Generation Antipsychotics

Newer antipsychotics (known as “atypical” or “second generation”) tend to have milder side effects than previous versions, which were known to cause abnormal body movements. Common atypical antipsychotics include:

• Seroquel
• Clozaril
• Risperdal
• Zyprexa
• Abilify
• Saphris
• Latuda

Alternative or Holistic Therapies

Holistic therapies are also effective at treating addiction and schizophrenia. The purpose of holistic therapies is to treat the whole person, and not just the symptoms. These can be beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies include:

• Relaxation techniques
• Nutritional therapy
• Animal-assisted therapy (e.g., emotional support dogs)
• Massage
• Adventure therapy (e.g., hiking or rock climbing)
• Mindfulness and meditation
• Art therapy and music therapy
• Yoga and Tai-Chi
• Equine-assisted (horse) therapy

Long-Term Recovery

Alongside these treatments, there are other ways to enhance your recovery by making personal lifestyle adjustments like the ones below:

Exercise

This can stimulate endorphins, which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises such as walking, running, swimming, cycling, or yoga.

Meditation

This can help calm anxious thoughts and reduce impulsive behavior, which is useful when recovering from schizophrenia and addiction.

Eating Well

The right diet can help repair damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy.

Avoiding Triggers

Learning to avoid triggers like certain people, situations, or circumstances can help prevent a desire to take drugs.

New Hobbies

While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.

Resources

If you or a loved one are struggling with schizophrenia and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Smith, A. (2020). What are the Different Types of Schizophrenia? Medical News Today. https://www.medicalnewstoday.com/articles/192770.

National Institute on Drug Abuse. (2020). The Connection Between Substance Use Disorders and Mental Illness. NIH. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness.

National Institute of Mental Health. (n.d.) Schizophrenia. NIMH. https://www.nimh.nih.gov/health/topics/schizophrenia/

National Institute of Mental Health. (n.d.) Schizophrenia. NIMH. https://www.nimh.nih.gov/health/statistics/schizophrenia.

Smith, K. (2020). Schizophrenia and Substance Abuse. Psycom. https://www.psycom.net/schizophrenia-and-substance-abuse.

Winklbaur, B., et al. (2006). Substance Abuse in Patients with Schizophrenia. Dialogues Clin Neurosci. 8(1), 37–43. https://10.31887/DCNS.2006.8.1/bwinklbaur.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

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