Schizophrenia and Substance Use
Schizophrenia is a disorder characterized by distorted perceptions of reality and disorganized thinking and speech. People who have schizophrenia experience periods of time where they lose contact with reality in the form of hallucinations and/or delusions. They may also experience low motivation and poor attention. It begins usually in late adolescence or early adulthood, often starting with a psychotic episode, or break from reality. Hospitalization is often needed for severe symptoms.
Symptoms of Schizophrenia
- Hallucinations: seeing, hearing, feeling or smelling things that are not actually there
- Delusions: false beliefs that others clearly realize are not true
- Disorganized thinking: jumbled speech, making up words, jumping between topics
- Odd or disorganized behavior (sudden agitation, disheveled appearance, inappropriate sexual behavior) or physical activity (bizarre body postures or excessive motor activity)
- “Negative” symptoms: reduced emotional expressiveness, apathy, social withdrawal, loss of pleasure in things that used to be enjoyable, diminished speech
Parents and family members often notice signs of schizophrenia when a young person insists on delusions like that the television is talking specifically to them, or that the government is after them. While many families first discover that a child has schizophrenia only after a psychotic episode, symptoms of psychosis can develop gradually, as a child has fleeting delusions, withdrawal, moodiness, or a reduced range of emotions, or neglecting hygiene. Noticing these “prodromal” symptoms and treating the adolescent with appropriate therapy can reduce the chance of full-blown schizophrenia in the future.
The recommended treatment for schizophrenia, called Coordinated Specialty Care, involves a combination of services coordinated by a group of professionals working with the patient and the family. Elements of the treatment include:
- Low doses of antipsychotic medication
- Cognitive behavioral therapy for psychosis (CBTp)
- Family education and support
- Educational and vocational rehabilitation
The most commonly prescribed drugs for schizophrenia are antipsychotic medications like risperidone (Risperdal) and olanzapine (Zyprexa).
Schizophrenia & Interaction With Substance Use
Some experts estimate that 50 percent of the young people seeking help after a psychotic episode report having used drugs or alcohol. Marijuana is the most common substance, but patients also report using alcohol, K2 (synthetic cannabis), LSD, cocaine and opioids.
In fact, multiple studies have shown that marijuana use in adolescence can make individuals who are vulnerable to schizophrenia have an episode earlier and perhaps more severe than they might have had they not used. For those who have had a first psychotic episode, continued substance use will make them more likely to have ongoing psychotic symptoms and more likely to have a relapse into another full-blown psychotic episode.
Conversations about substance use are an important part of treatment for schizophrenia. After a first episode, young people are eager to get back to normal, to resume their old lives, and that may mean returning to substance use. For young people with schizophrenia, it may be hard for them to accept the fact that their friends may be able to use substances, especially marijuana, but that for them, it could interfere with recovery and contribute to a recurrence of symptoms.
Something that works in favor of giving up substances is to focus on the desire to avoid further hospitalizations. It’s also important for parents and clinicians to understand what substance use did for their young adult (asking what need it filled, or why use began in the first place) and encourage him or her to replace it with healthy alternatives.