What is the relationship between schizophrenia and the various forms of addiction?
Substance abuse disorders often co-occur with mental illnesses. Although they are separate medical conditions, the relationship between addiction and mental disorders is closer – and more complicated – than most people realize.
In fact, a person with a substance abuse disorder is more likely than not to also struggle with a comorbid psychiatric condition, and vice versa. According to the Journal of the American Medical Association:
- Among people with a mental illness, roughly half have a Substance Use Disorder (SUD).
- 53% of people who abuse illicit or prescription drugs have a diagnosable mental disorder, as do 37% of people with an Alcohol Use Disorder (AUD).
One of the most debilitating mental illnesses that can present simultaneously with addiction is schizophrenia.
What Is Schizophrenia?
Schizophrenia is a severe mental disorder that affects the way a person feels, things, and behaves. It affects more than 21 MILLION people worldwide. It is the third-most disabling condition, even ahead of blindness or paraplegia.
Although there is no objective test for the condition, scientists believe that an imbalance in the person’s brain chemistry plays a prominent role. The brain’s reward system and the way it processes dopamine may be involved.
Dopamine is a neurotransmitter involved in reward, pleasure, and motivation. Increasing evidence points to its involvement in mental illness, as well.
Of special relevance, disruptions in normal dopamine production also play a prominent role in the development of an addiction.
In 2012, the National Institute on Drug Abuse funded a study that determined that patients who were diagnosed with co-occurring addictive and schizophrenic disorders suffer from both increased dopamine sensitivity in the part of the brain that causes psychotic symptoms and decreased dopamine sensitivity in the region that controls reward.
These dual impaired sensitivities make the person vulnerable to a vicious, self-perpetuating cycle of schizophrenic symptoms and self-medication that offers a temporary reprieve which ultimately WORSENS those symptoms.
There are two crucial periods when normal brain development is most vulnerable to disruption –before birth and during puberty. Malnutrition, exposure to certain viruses, childhood trauma, and marijuana use are all possible environmental factors. Oddly, living in a city during childhood or early adulthood DOUBLES the chances of developing schizophrenia.
Schizophrenia frequently manifests during adolescence or early adulthood. In fact, in 23% of females and 40% of males diagnosed with the illness, it developed before the age of 19.
Symptoms of schizophrenia include:
- Hallucinations affecting all five senses
- Movement disorders
- Impaired executive functions – poor ability to make reasonable decisions
- Lack of focus
- Loss of motivation
- Memory problems
- Decreased enjoyment of everyday life
- Impaired verbal ability
- Inability to form relationships
There is no cure for schizophrenia, but it can be managed with medication and ongoing support.
Schizophrenia and Substance Abuse
People with schizophrenia have much higher rates of substance abuse than the rest of the general population. Excluding nicotine, almost 45% of schizophrenics will have a substance abuse disorder at some point in their lives, and 14% are dependent or addicted RIGHT NOW.
The usage rates among schizophrenics, by substance are:
- Alcohol—use 65%, but almost 34% have an Alcohol Use Disorder at some point
- Marijuana—as high as 51%
- Cocaine—as high as 23%
- Opioids – 4%
Schizophrenia and Marijuana – The Biggest Danger
Cannabis use during adolescence is recognized as a significant causal factor that can add to the risk. Research has shown that individuals who are heavy marijuana users before they turn 18 have a 600% greater likelihood of developing schizophrenia within the next 15 years.
Schizophrenia and Smoking – The Deadliest Addiction
For decades, the extremely-high smoking rates among schizophrenics was thought to be merely a form of self-medication. But a 2015 meta-analysis of 61 separate studies conducted by King’s College in London strongly suggests that the nicotine in cigarettes can alter the brains of genetically-vulnerable people.
- 57% – over half – of people diagnosed with psychosis were already smokers at the time of their first episode.
- Daily smokers have DOUBLE the risk of schizophrenia as non-smokers.
- On average, people who smoke develop the illness a year earlier than non-smokers.
The negative health complications caused by smoking is the biggest reason why schizophrenics die up to 25 years earlier than those without the disorder.
Schizophrenia and Alcohol—Making It Worse
One of the biggest dangers of alcohol abuse among schizophrenics is that alcohol-induced psychosis resembles schizophrenia. This can mask the onset of the disease, interfere with a proper diagnosis, and delay effective treatment.
Heavy alcohol consumption by schizophrenics can worsen hallucinations, increase hostility and aggression, trigger violent or disturbed behaviors, heighten anxiety, and deepen depression.
Schizophrenia and Cocaine – Self-Medicating Negative Symptoms
As with other drugs of abuse, schizophrenics may use cocaine to temporarily relieve anxiety, depression, and sociability. However, cocaine abuse negatively affects attention and memory, and these impairments can in turn increase anxiety, deepen depression, and worsen feelings of isolation.
Schizophrenia and Methamphetamines – Meth on the Brain
In 2011, a group of Canadian researchers examined 10 years’ worth of California hospital records, and they found that methamphetamine users are at increased risk. Compared to users of other substances – cocaine, alcohol, or opioids – meth users had up to a three times greater likelihood for a later diagnosis of schizophrenia.
The hypothesis is that repeated meth use increases the brain’s sensitivity to dopamine.
Schizophrenia and Opioids – Smaller Numbers, Bigger Dangers
Because of the strong depressant effect of prescription painkillers and heroin, opioids are not an extremely-common drug of choice for schizophrenics. Compared to other substances, one might conclude that they aren’t as big a concern.
However, the rate of hospitalization for schizophrenics who abuse opioids is 45% higher than those who abuse amphetamines, and 81% higher than cannabis users.
What Can Be Done for Schizophrenics Who Abuse Drugs or Alcohol?
With regular medication and ongoing support, schizophrenics can realize a large degree of independence and relatively normal quality of life. Early intervention is crucial. The sooner treatment begins, the sooner the progression of either co-occurring disorder can be halted, and the better the chance of a successful outcome.