For people with a diagnosis, the relationship between schizophrenia and substance abuse is complex but common, as almost 50% of people also experience this disorder. Substance abuse may include using specific substances such as alcohol, tobacco, and other illicit drugs. Such a high rate of schizophrenia and substance abuse is problematic because individuals diagnosed may experience non-compliance with treatment options, hospitalizations, and an increased risk of suicide.
What is Schizophrenia?
Schizophrenia is a mental illness that belongs to the disorder class of Schizophrenia Spectrum and Other Psychotic Disorders according to the National Alliance on Mental Illness and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Schizophrenia is diagnosed if two or more of the following symptoms are present for a significant amount of time during one month or less if treated successfully. At least one of these symptoms must be delusions, hallucinations, and disorganized speech, including incoherence or frequent derailment.
Other symptoms may include grossly disorganized or catatonic behavior. Other symptoms may also have negative symptoms such as diminished emotional expression or a lack of motivation. Schizophrenia is marked by a decrease in the level of functioning in one or more of life’s major areas such as self-care, work, and interpersonal relationships for at least six months and affects 1% of the population worldwide.
Schizophrenia and Substance Abuse
Over the past 20 years, there have been several hypotheses to explain the relationship between schizophrenia and substance abuse.
The Diathesis-Stress Model
Suggests that a genetic vulnerability combined with environmental factors can cause someone to develop schizophrenia.
The Cumulative Risk Factor Hypothesis
Suggests that individuals with schizophrenia have an increased risk of substance use disorders because of the cumulative effects of factors ranging from poor cognitive functioning, social functioning, and educational and vocational functioning to poverty, victimization, and alternative social environments.
The Self-Medication Hypothesis
Suggests that addiction is based on the desire to decrease some medications’ symptoms or side effects. While this hypothesis is possible, it is unlikely as most studies have reported very little to no relationship between symptoms, addiction, medication, and side effects.
The Primary Addiction Hypothesis
Suggests that schizophrenia and substance abuse share a common pathway. addiction may be related to a dysfunction of the brain reward circuit in individuals with schizophrenia. These ideas may not be mutually exclusive. It is not yet clear which of these theories are most strongly supported with clear evidence because of the ongoing nature of the research.
For our purposes, the existing assumptions will be used to develop a unifying theory that may explain all of the current hypotheses together to understand better individuals who may be suffering from schizophrenia and addiction.
Substance Abuse in Adolescence
Substance abuse in adolescence may be an additional risk factor for the later appearance of symptoms and may increase the risk for developing substance abuse later in life. Additional research that studies adolescent brain development and substance abuse is needed further to determine more about this relationship.
The genetic vulnerability to schizophrenia could be dysfunctional within brain circuits involved in motivation and reward, which may drive both the start of and the continuation of substance abuse.
Ongoing and future studies on the adolescent brain, cognitive development, and substance abuse that look at the markers of brain function before the appearance of symptoms in adolescents who use substances could help further understand this relationship.
Dopamine Regulation
The processing of rewards in healthy individuals is related to dopamine activity which may be impaired in individuals with schizophrenia. It has been found that individuals with schizophrenia and substance abuse have decreased dopamine release. This reduced dopamine release may be due to substance abuse in adolescence for these individuals. There might be a hyperactive dopamine system in such individuals, and this hyperactivity may further contribute to their vulnerability toward substance abuse.
A dysfunctional circuit may lead adolescents with no symptoms at a greater rate than other adolescents without this dysfunction. The substance abuse itself may trigger the onset of symptoms and lead to continued substance abuse.
Even if substance abuse does not begin before the start of psychosis, the deregulated circuitry of these individuals may lead them to continue to have a high rate of substance abuse and to continue such abuse once it begins despite its adverse consequences.
It would be likely that adolescents who develop a diagnosis of schizophrenia would begin to show dysfunctions in brain reward circuitry such as dopamine hypersensitivity before the onset of their symptoms during adolescence.
Genetic Factors
Genetic factors may contribute to both psychosis and addiction, which leads to both schizophrenia and substance abuse. Three specific genes, brain-derived neurotrophic factor (BDNF), catechol-O-methyltransferase (COMT), and protein kinase B (AKT), have attracted the most attention in the scientific literature for their relationship. The vulnerability to genetic factors may also appear prior to the appearance of any psychotic episodes.
Since schizophrenia and substance abuse may come from a common vulnerability in these individuals, understanding and targeting both mental health conditions and substance abuse together may improve overall outcomes for these individuals.
Schizophrenia Treatment
Individuals with schizophrenia and substance abuse issues should know that they are not alone and that schizophrenia treatment is available. Schizophrenia treatment may help manage life’s major areas such as self-care, work, and interpersonal relationships. The treatment team, including a case manager, psychiatrist, and other mental health professionals, may guide treatment programs.
The most commonly prescribed medications are atypical antipsychotics. Other treatments such as anti-anxiety meds, antidepressants, individual and family therapy, vocational rehabilitation, supported employment, support groups, and social skills training.
With the help of Story Wellness most people with schizophrenia can manage their disorder with appropriate treatment and lead productive and rewarding lives; if you’re interested in learning more about a treatment plan, call (866) 476-2823 today.
