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schizophrenia and drug use
December 3, 2018

Schizophrenia and Drug Use

There is an in inextricable link between mental illness and substance abuse—particularly schizophrenia and substance abuse. Although schizophrenia is generally classified under the umbrella of mental illness, it is actually a neurological disorder of serious import and clinical significance. The disorder, which is characterized by auditory and visual hallucinations, disorganized thought processes, delusional beliefs, and highly eccentric personality traits, is debilitating for those afflicted with it and overwhelming for family members and friends. Schizophrenia causes cognitive distortions and maladaptive behaviors that interfere in healthy social and professional functioning and frequently leads to psychiatric hospitalization, homelessness, unemployment, suicide ideation or attempts, and alienation from important relationships. As a result, approximately half of those suffering from schizophrenia concurrently abuse alcohol and drugs.

Schizophrenia is considered an early-onset disorder, with the majority of patient’s first experiencing symptoms in their teens. Although the prevalence of schizophrenia is considered relatively low in the general population, co-occurring substance abuse disorders (SUDs) are higher than average. For many schizophrenic patients, the devastating effects of the disorder lead to a variety of unhealthy coping mechanisms—the most common being substance abuse. The simultaneous treatment of schizophrenia and substance abuse is notoriously difficult and requires a nuanced, multidimensional approach that includes aggressive symptom management combined with genuine compassion.


Within the general cluster of symptoms that define schizophrenia, individual variations (or sub-types) appear that help clinicians better understand and treat the disorder. For example, paranoid schizophrenia is the most common expression and is characterized by delusional thinking and beliefs. Paranoid schizophrenics are often haunted by thoughts and feelings involving persecution, emotional or physical threats, imprisonment, and loss of control by other humans or even aliens. In some cases, paranoid schizophrenia is also defined by highly imaginative but implausible conspiracy theories and self-proclaimed relationships with immaterial beings. The dialogue and behavior associated with extreme paranoid schizophrenia can resemble the script of a science-fiction movie, and those suffering from its effects may become aggressive, erratic and socially isolated due to their debilitating fear of others.  Other dominant expressions of schizophrenia include:

  • Disorganized schizophrenia—this fairly common expression of schizophrenia is characterized by mental chaos, bizarre speech and unusual emotional reactions. Disorganized schizophrenics tend to suffer less from auditory and visual hallucinations- delusions and more from eccentricity. This creates difficulty with autonomous functioning and normal social interaction. In some cases, professional stability and success become impossible as a result of the incomprehensible speech and extremely eccentric behavior.
  • Undifferentiated schizophrenia—this less common subtype is comprised of individuals suffering from symptoms of the disorder that cannot be defined by other dominant expressions. Although they may still experience hallucinations, or display eccentric behavior and delusional beliefs, they do not meet official diagnostic criteria and often suffer from lack of treatment.
  • Residual schizophrenia—this form of schizophrenia is the most subtle and difficult to detect—sometimes eluding detection altogether. Residual schizophrenics no longer exhibit outwardly obvious symptoms, and clinicians have difficulty diagnosing it despite its subtly debilitating effects.


Regardless of which dominant expression schizophrenia takes, signs and symptoms are divided into four main quadrants. This helps simplify the often painstakingly detailed, tedious process of disentangling a complex equation of interwoven symptoms. The quadrants are, in no particular order:

  • Cognitive symptoms—are characterized by the inability to appropriately use language, difficulty learning, chaotic, disorganized thinking, and faulty beliefs (usually involving persecution and/or grandiose fantasies).
  • Behavioral symptoms—are characterized by social withdrawal, self-imposed isolation, irrational fear of eating, drinking, or touching others, loss of motivation, neglected personal hygiene, erratic, unpredictable and disturbing behavior, and dangerous impulsivity.
  • Emotional symptoms—are characterized by a flat, emotionless expression (poker face), nonsensical responses, lacking empathy or patience with others, and erratic mood shifts.
  • Sensory symptoms—are characterized by seeing things that do not exist, otherwise known as visual hallucination, or hearing voices that are inaudible to others and imagined—auditory hallucination. In many schizophrenics, both auditory and visual hallucinations occur simultaneously.


Smoking is, by far, the most commonly abused substance associated with schizophrenia. In fact, people suffering from schizophrenia are addicted to nicotine at triple the rate of the average person. While approximately 25 percent of the general population is addicted to nicotine, the number is between 75 and 90 percent for schizophrenics. As with alcohol, the relationship between schizophrenia and smoking is highly complex and theorized to be the result of the additional burden of physical, emotional and psychological stress shouldered by those suffering from the disorder. Unfortunately, nicotine may interact unfavorably with the antipsychotic medications used to treat schizophrenia, and nicotine withdrawal can cause a gradual worsening of symptoms.


Alcohol is the second most widely abused substance associated with schizophrenia. According to the National Institute on Drug Abuse (NIDA), approximately one-third of schizophrenics become an alcoholic within their lifetime. Many researchers, scientists and clinicians attribute this high prevalence of alcoholism to the complex web of “biological, psychological and environmental factors” that negatively affect schizophrenics on a daily basis. This frequently causes schizophrenics to self-medicate in response to their considerable challenges and creates a vicious cycle.

Sadly, schizophrenia and alcoholism are difficult to treat in tandem and usually result in suboptimal treatment outcomes. Concurrent schizophrenia and alcoholism are also associated with:

  • Social and professional instability
  • Elevated symptoms and recurrence
  • Volatile or violent behavior
  • Legal and medical problems
  • Incarceration in jails, prison and psychiatric hospitals
  • Irreversible brain damage


Polysubstance drug abuse involving mind-altering substances such as potent opiates and illicit street-drugs (in addition to alcohol and cigarettes) can have a dramatically negative effect on schizophrenia. Even in individuals with relatively normal genetics and a strong physical constitution, polysubstance drug abuse can take a crippling toll. With regard to schizophrenia, specifically, the disorganized thought patterns, auditory and visual hallucinations, erratic behaviors, and communication difficulties react with far greater volatility to the presence of mind-altering substances and create long-term damage. 

The already disjointed, neurologically dysfunctional brain of a schizophrenic is not designed to withstand the assault of hard-core substances. Although “typical antipsychotic” medications such as Haldol and Proxilin, and “atypical antipsychotic” medications such as Seroquel and Risperdal can be very effective in alleviating certain symptoms of schizophrenia—they interact badly with mind-altering substances and run the risk of producing serious, potentially fatal, complications. For this reason, it is imperative that individuals suffering from schizophrenia refrain from any unnecessary drug use.


In addition to whatever primary medications are used to treat schizophrenia, a variety of evidence-based Food and Drug Administration (FDA) pharmacological interventions are available to treat co-occurring substance abuse disorders (SUDs).  Empirical research suggests that professional, medically managed treatment— although not always effective—can provide lasting relief from concurrent schizophrenia and drug addiction. In such environments, highly qualified clinicians and licensed medical professionals unite to provide state-of-the-art care. During treatment, a variety of behavioral therapies are incorporated into the protocol including:

  • Cognitive behavioral therapy (CBT)—this highly celebrated modality provides the tools necessary to challenge self-defeating thoughts, overcome conceptual limitations and question cognitive distortions.
  • Trauma-focused therapy (TFT)—a variety of related modalities including eye-movement desensitization and reprocessing (EMDR) are combined to help treat unresolved trauma and heal from emotional scarring and pain.
  • Family therapy—a critical modality for the families of those suffering from co-occurring schizophrenia and drug abuse, family therapy approaches schizophrenia and substance abuse as a collective problem rather than an individual condition.
  • Individual therapy—this popular modality involves one-on-one psychotherapy sessions facilitated by a licensed mental health professional. Individual psychotherapy is considered a vital part of inpatient and outpatient treatment.
  • Group therapy—this therapeutic format, performed among peers, provides an excellent outlet for normalizing maladaptive behaviors and discussing effective coping strategies.


Being hit with a concurrent diagnosis of schizophrenia and substance abuse can be extremely daunting. It is common for individuals and families suffering from both to feel hopeless and overwhelmed. However, despite these totally normal, understandable feelings, there is a multitude of available treatment options—with many including customizable, comprehensive care. Help is just a phone call away

For more about schizophrenia and drug use, check out these related articles:


Dialogues in Clinical Neuroscience. Substance abuse in patients with schizophrenia. March, 2006.

Schizophrenia Research. Substance use in youth at risk for psychosis. March, 2017.  

The Journal of Psychosis and Related Disorders. Substance Use Disorders in Schizophrenia—Clinical Implications of Co-Morbidity. May, 2009.

Current Opinion in Psychiatry. Schizophrenia and substance abuse: Is schizophrenia forgotten? May, 2017.