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Living With Schizophrenia and Addiction

Understanding schizophrenia and how it influences substance abuse.

Living with Schizophrenia and Addiction

Article Contents

What is Schizophrenia?

The World Health Organization (WHO) defines schizophrenia as a chronic and severe mental disorder that affects about 20 million people worldwide. Schizophrenia is characterized by distorted thoughts, perceptions, emotions, language, sense of self, and behavior. Some of the common symptoms of schizophrenia include hearing and seeing things that are not there and delusions in the form of false beliefs.1

Living with schizophrenia is commonly associated with a high degree of disability, and it usually affects the individual’s educational and occupational performance. Most people with schizophrenia have problems with work, school, and relationships (friendships, romantic relationships, and platonic relationships).

Schizophrenia is not a multiple personality disorder. Schizophrenia is characterized by psychosis, a mental illness that prevents a person from telling what’s real and what is imagined. People with psychotic disorders lose touch with reality, and the world can be a confusing mirage of thoughts, images, and sounds. The sudden change in personality and attitude is known as a psychotic episode.

Read on to learn more about the connection between addiction and living with schizophrenia and how to treat it in recovery as part of a dual diagnosis.


Psychotic Symptoms

Psychotic symptoms usually show up in men in their late teenage years or early 20s. Women are mostly affected in their early 20s and 30s.2 The period when the first signs of illness show and before the full psychosis takes place is called the prodromal period.3

The early symptoms can last for days, weeks, or years. However, schizophrenia can be hard to spot in the early stages since there is no specific trigger. The only noticeable symptom is erratic behavioral changes.

Some of the early signs of schizophrenia include:

  • Social withdrawal/ lack of participation
  • Trouble with concentration
  • Trouble with grades
  • Erratic temper flares
  • Insomnia

Beyond the early signs of schizophrenia, the establishing signs of this mental illness are called positive symptoms:

Delusions: These are strange, mixed, and false beliefs that aren’t based on reality. These beliefs are usually so strong and convincing to the patient that they do not give them up even after being proven wrong.

Hallucinations: Hallucinations are more profound forms of delusions. Hallucinations are sensations that are not real. One of the most common forms of hallucination is hearing voices. The voices in a patient’s heads commonly tell or command them what to do. Other less common forms of hallucinations include smelling strange odors, having funny tastes in the mouth, and the feeling of sensations on the skin when nothing is touching that person.

Catatonia: This is a condition that causes the person to stop speaking and be fixed in a single position for a long period.

Other symptoms of schizophrenia include cognitive symptoms, negative symptoms, and disorganized symptoms. 3

What Is Living with Schizophrenia Like?

People with schizophrenia usually have difficulty keeping a job, maintaining relationships, and caring for themselves. They often rely on family and friends for help. Schizophrenia is often misunderstood by healthcare professionals and family/friends, and this makes it difficult to identify and provide patients with the necessary help. However, schizophrenia is treatable, and in many cases, the patient can lead a normal and productive life.

Patients should take an active role in managing their illness. One can learn the warning signs of a relapse and have an effective plan of action for symptoms. A patient can also learn to develop coping mechanisms to deal with the worst symptoms.

Drug abuse and schizophrenia often occur together. Thankfully, many wellness centers will offer treatment for both drug addiction and schizophrenia.

Is Schizophrenia Linked to Substance Abuse?

Research has shown that a high percentage of people diagnosed with Schizophrenia also struggle with addiction. This form of illness is known as co-occurring disorders, and it usually involves psychotherapy, substance abuse counseling, medication, and involvement in support groups.


It is estimated that 50% of individuals suffering from schizophrenia have a history of substance abuse.4 It is suggested that most people with schizophrenia use substances as a way of self-medicating anxiety and depression.

While substance abuse is not known to cause schizophrenia, it is known to be one of the active environmental triggers. Someone with a prevalent genetic disposition to schizophrenia can develop an active case of disease if they are exposed to extended drug use.

Studies show that people with mood or anxiety disorders are twice as likely as the general population to suffer from substance abuse. Statistics from 2012 show that up to 8.4 million adults in the United States have both mental and substance use disorders (SUD).5

Around 53.7 percent of people with both a mental disorder and a substance use disorder receive no treatment.6

Risk Factors for Schizophrenia and Addiction


For many patients with mental disorders such as schizophrenia, studies show that substance use in patients with first-episode psychosis ranges from 30-70%. Substance use begins before psychosis for many patients, making self-medication a strong risk factor for mental illnesses such as schizophrenia.

Genetic vulnerability

Genetic factors are thought to play an important role in susceptibility to schizophrenia and co-occurring SUD. Polygenic risk scores for schizophrenia are also associated with cannabis use, cocaine use, nicotine use, and severe alcohol use.7

Environmental vulnerability

Viral infections and exposure to toxins or highly stressful situations can trigger schizophrenia in people whose genes make them more susceptible. This is linked to the fact that schizophrenia often occurs when the body experiences hormonal and physical changes, like what occurs during the teen and young adult years.

Neurobiological links

Research shows that people with abnormal brain structures are more likely to develop schizophrenia. However, this is not true for everyone that eventually develops this mental disorder.

Living with Schizophrenia and Nicotine Addiction

How many people live with it?

It is estimated that 60-90% of patients with schizophrenia experience tobacco dependence. This rate is higher than the general population, where the percentage of smokers varies between 25-46%.

What is it like?

A study shows that for adults with increased susceptibility to schizophrenia or who are already suffering from it, there is a significantly higher risk of taking up smoking. It is one of the many reasons for nicotine addiction and its consequences are becoming a prevailing problem in clinical psychiatry.

People with schizophrenia are often heavy smokers, meaning they smoke at least 20 cigarettes a day, with a shorter inter puff interval. They are also likely to smoke cigarettes with higher nicotine content.

Coping skills

People suffering from schizophrenia find it more difficult to quit smoking mostly because of withdrawal symptoms like irritability, poor concentration, impatience, and anxiety, and partly because they do not have the support and motivation to do it successfully.

Living with Schizophrenia and Cannabis Use

How many people live with it?

An analysis of several studies indicates that cannabis is one of the most commonly abused substances among people with schizophrenia. This is especially true for young people as they tend to abuse cannabis more often than alcohol.

What is it like?

According to a 2017 study, the genes that put you at risk of developing schizophrenia may also make it more likely that you will use marijuana. The study found that cannabis users are 1.37 times more at risk of developing schizophrenia than those who did not use the drug.8

Coping skills

It should be noted that you may be at a higher risk of relapsing, developing worse symptoms, and even be hospitalized if you have schizophrenia and use marijuana. Cannabis has been found to contribute to anxiety and paranoia, two conditions closely related to schizophrenia.

Living with Schizophrenia and Cocaine Addiction

How many people live with it?

Nearly 50% of individuals with schizophrenia experience comorbid substance abuse disorder after the initial diagnosis of psychosis, most commonly for cocaine.

What is it like?

People with schizophrenia have higher rates of impulsivity, sensation seeking, and social anhedonia (a disinterest in social contact). These symptoms can lead to impulsive drug use to obtain a heightened sensation. Cocaine use may evoke positive feelings in someone with schizophrenia, leading to further cocaine use as a way of suppressing negative symptoms.

Coping skills

To keep cocaine addiction and schizophrenia under control, it is necessary to combine different treatment types. The goal is to keep the psychotic symptoms of schizophrenia controlled while reducing the cravings for cocaine. Common methods include psychotherapy, pharmacotherapy, and behavioral therapy.

Treating Schizophrenia and Addiction

There are three major methods of treating the co-occurrence of schizophrenia and substance use disorder.


Cognitive-behavioral therapy (CBT) is a common type of therapy used to treat co-occurring disorders like schizophrenia and addiction. The patient is assisted in identifying specific behaviors that contribute to their disorders. This form of therapy also helps patients learn to manage their symptoms by discovering what auditory hallucinations and other symptoms persist after taking antipsychotic medications.

Motivational Interviewing

A major problem in treating schizophrenia is the presence of disturbing behaviors such as non-adherence to medication or increased substance abuse. These behaviors have negative effects on treatment. Treatment strategies that incorporate forms of motivational interviewing have been used to influence such behaviors.

Motivational interviewing is an intervention technique that has proved successful in altering the behavior of substance abusers and has shown promise in other sectors of health care. This technique focuses on using a non-judgmental and empathetic attitude when talking to patients. This strategy is used in conjunction with other treatment methods such as CBT and medications.


Detox is usually the first step in treating a person with co-occurring conditions. Once the body is free of substance, the patient is assessed for schizophrenia symptoms. Antipsychotic medications are usually prescribed to people with schizophrenia to aid chemical imbalances in the brain. Most of the time, several drugs are tested before the right medication is found.

It is possible to recover from schizophrenia and addictions with the help of proper treatment, the support of loved ones, and consistency.

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