Schizophrenia and Addiction
What is Schizophrenia?
Schizophrenia is a severe neurological disorder (or series of concurrent disorders) that causes a break between reality and what a patient is experiencing. Although schizophrenia is often lumped in as a “mental illness,” it would be more accurately defined as a group of different disorders that work together to alter an individual’s sense of reality. Because there are so many different (sometimes unrelated) symptoms, schizophrenia can be hard to diagnose and even harder to treat. Delusions, hallucinations, racing thoughts, and changing personality traits can all be symptoms of schizophrenia. These traits can be frightening and difficult to manage, for both someone suffering and friends/family.
Schizophrenia can leave individuals seriously impaired vocationally, relationally, cognitively, and behaviorally. This is due to the interference of normal thought processes. Schizophrenia can have severe consequences like homelessness, hospitalization, unemployment, and suicidal ideation. These symptoms and repercussions can begin as early as the teenage years.
Types of Schizophrenia and Accompanying Symptoms
While symptoms can vary wildly from person to person, there are several types of schizophrenia that have unique symptoms and treatments.
Paranoid schizophrenia is the most commonly diagnosed form. The most common symptom is a recurring delusion of persecution or constant danger. Other typical characteristics include:
- An excessive obsession with conspiracy theories
- Fears of being hunted or chased
- Hearing “voices” telling you to harm yourself or others
Socially, sufferers of this type of schizophrenia will often self-isolate, exude hostility or awkwardness, or fear being around others.
Disorganized schizophrenia can be characterized by chaotic thought patterns, bizarre or abrupt speech, and out-of-place emotional reactions. While bizarre behavior and speech are more common, hallucinations and delusions of danger are generally less common. Often, people suffering from disorganized schizophrenia will have trouble caring for themselves or others, maintaining relationships or employment, or being understood.
Residual schizophrenia is noted in those who no longer directly suffer from the disease but who have been greatly affected by it in the past. This refers to continuing trauma or behavioral issues stemming from previous battles with a different type of schizophrenia. While someone may “overcome” schizophrenia through medication and therapy, there can be long-lasting social effects, and there may be some less debilitating daily symptoms still.
This is defined by the inability to meet the definitions of other subtypes. There could be various symptoms from paranoid or residual schizophrenia such as manic speech, or hallucinations that are intermittent or inconsistent. However, these might not show enough to meet firm diagnostic criteria.
The word “schizophrenia” comes from two Greek words meaning “split mind.” This term was invented by Professor Paul Eugen Bleuler, a psychiatrist who researched symptoms of schizophrenia. According to the Indian Journal of Psychiatry, Bleuler defined schizophrenia as a “splitting of the processes involved with emotion, cognition, behavior, and communication.”
Those suffering from schizophrenia may experience a world that does not align with reality or seemingly with their behaviors. They will often lack the ability to communicate feelings and experiences effectively and will commonly be misdiagnosed or dismissed as “crazy.” Their fears, hallucinations, or beliefs in conspiracies may prevent them from taking part in “normal” aspects of society such as employment and social relationships.
Effects of Schizophrenia
Schizophrenia can affect every aspect of an individual’s mind and personality. One of the most common symptoms is the presence of psychosis, or experiences that conflict dramatically with reality as experienced by others. The symptoms of schizophrenia can be loosely categorized according to whether they affect the sensory experience, thoughts, and learning, or social interaction and communication:
- Sensory symptoms: Visual or auditory hallucinations are often the first sign of the onset of schizophrenia. These can include seeing or hearing things that are not there and aren’t experienced by others, as well as hearing “voices.”
- Cognitive symptoms: Schizophrenia is often marked by the inability to understand or utilize language in comprehensible ways, disorganized thinking, difficulty learning in conventional ways, and memories or beliefs that are patently untrue or outrageous.
- Behavioral symptoms: Withdrawing from social situations and self-isolation are common effects of schizophrenic symptoms. Individuals often feel out of place or even fearful of interacting with others. This can even include fear of physical contact, eating and drinking, and wild or impulsive behavior.
- Emotional symptoms: Individuals suffering from schizophrenia will often develop a lack of empathy for others, intense focus on only their experience, bizarre or unexplained mood changes, and even complete loss of emotional resonance.
Warning Signs of Schizophrenia
Symptoms of schizophrenia often appear for the first time when people are in their late teens or twenties. However, statistics show the average patient does not receive treatment for up to eight years after diagnosis. Schizophrenia is more common among males than females, and symptoms often manifest during key transitions or trauma in a young person’s life, such as going to college, experiencing the death or loss of a close friend or family member, or living through the breakup of a family.
Individuals who have seemed happy and normal may become increasingly eccentric and odd, displaying incomprehensible behavior and talking in strange ways. Some of the early signs may include:
- Bizarre changes in speech or behavior
- Sudden loss of interest in favorite hobbies or relationships
- Neglect of grooming and hygiene
- An intense focus on negative or destructive thoughts or conspiracies
- Self-isolation from friends and family
- Loss of ability to control impulses such as binge eating or drinking
- Lack of awareness in the surrounding world
- A flat or unemotional facial expression
- Failure to finish projects or meet commitments
- Inability to focus on any one topic for very long
A complete medical exam and psychiatric evaluation can help to determine whether an individual is suffering from schizophrenia or another neurological disorder.
Trauma and Schizophrenia
While there is still debate about whether trauma directly causes schizophrenia, there is research to show that someone who suffered from childhood trauma (divorce, abuse, etc.) is as much as three times as likely to develop schizophrenic symptoms later in life. In addition, research shows that the more severe the trauma, the higher the likelihood of developing a serious mental health disorder like schizophrenia. There is even evidence to support that the type of trauma one experiences can affect the symptoms of developed disorders.
It is certainly true that trauma occurring after the onset of schizophrenic symptoms can significantly worsen said symptoms. Additional trauma can lead to co-occurring disorders such as post-traumatic stress disorder (PTSD), or even push someone to begin abusing substances such as alcohol. Separately, these conditions can pose serious challenges to a person’s ability to live a “normal” life — together, they can become overwhelming and debilitating without proper care and support.
Schizophrenia and Addiction
The rate of substance abuse is significantly higher among individuals with schizophrenia than among the general population. Research identifies the most commonly abused legal and illegal drugs among schizophrenic patients as alcohol, nicotine, cocaine, and marijuana. Substance use will generally intensify schizophrenic symptoms, and drastically increase the chances of severe outcomes like incarceration, job or relationship loss, hospitalization, or suicide attempts.
Because symptoms of schizophrenia are often similar to symptoms of substance abuse, it can be difficult to distinguish between the two. Overlapping symptoms, such as slurred or unintelligible speech, can hinder the chances of an accurate diagnosis. It is extremely important to isolate the onset of symptoms to help identify a treatment plan that speaks to both schizophrenia and drug use. Treatment of schizophrenia combined with a substance use disorder (a condition known as a dual diagnosis or co-occurring conditions) is complicated by the paranoia, disordered thought patterns, and communication difficulties caused by schizophrenia.
The two most commonly abused substances, alcohol, and marijuana are both central nervous system depressants that can have a sedative effect on an overactive mind fraught with hallucinations or delusional beliefs.
Conversely, common stimulants such as cocaine, amphetamine, and methamphetamine can help the mind feel more focused, at least temporarily, and may help to sustain feelings of grandiosity and elation in high-energy phases of the disorder.
Treatment for Schizophrenia and Addiction
Although there is no “cure” for schizophrenia, patients can find some relief through a combination of psychiatric medicine and consistent therapy. Depending on the type of severity of schizophrenia, individuals may be able to return to relative “normalcy” if the right combination of medication and therapy can be found. Antipsychotic drugs can help reduce the severity of hallucinatory experiences and delusional beliefs, which allows these clients to experience the world more normally and relate to others in more satisfying ways.
If someone is experiencing both schizophrenia and addiction, it’s critical to seek treatment for both disorders and find a therapist who specializes in co-occurring conditions. Most substances, including commonly abused ones like alcohol or narcotics, can exacerbate the symptoms of schizophrenia. Conversely, many people who suffer from schizophrenia may exhibit some of the same symptoms (unintelligible speech, erratic behavior) as someone who has taken too much of a particular substance.
Types of Treatment for Schizophrenia and Drug Use
The symptoms of schizophrenia can leave a person’s life in complete disarray. Non-medicinal treatment methods are an essential part of helping someone cope with the struggle schizophrenia can cause. These treatments may include case management, family therapy, support groups, occupational counseling, and financial or legal resources. In order to address the psychological and behavioral symptoms of schizophrenia, and the poorly executed coping mechanisms of addiction, treatment must include a combination of intensive therapeutic services, such as the following:
- Individual therapy: One-on-one psychotherapy sessions with a licensed mental health professional or addiction specialist
- Group therapy: Therapeutic meetings in which individuals share common experiences and discuss ways to overcome
- Family Systems Therapy: This type of therapy involves an entire household and treats an individual’s behaviors as potentially a side effect of family trauma or dysfunction
- Cognitive Behavioral Therapy (CBT): A therapeutic method that helps individuals transform negative thought patterns into more positive behaviors
- Trauma therapies: Modalities such as Seeking Safety and Eye Movement Desensitization Reprocessing (EMDR) where clients seek to resolve past traumas and heal from unprocessed emotional pain
Inpatient and Outpatient Treatment
Substance abuse treatment can take place on an inpatient or outpatient basis and has flexibility based on the severity and longevity of symptoms. For someone with a dual diagnosis of schizophrenia and drug use, a fairly intensive residential treatment plan may be the best option. Because inpatient therapy provides structure and freedom from the distractions of the outside world, many patients choose this option to attack their dual diagnosis head-on.
After completing an intensive residential program, the client can then move to a partial hospitalization program (PHP) or outpatient treatment. An extensive support system will be required as the client makes the transition from rehab back to “normal living.” Sober living programs can provide a safe and supportive setting where individuals in recovery can practice their coping skills and prepare to integrate back into the community.