Schizophrenia and Addiction

Schizophrenia is a severe long-term mental health condition that causes a variety of psychological symptoms. Schizophrenia is a major illness. At any one time, about 220,000 people are being treated for schizophrenia in the UK by the NHS.

Schizophrenia is often considered a form of psychosis, meaning that if you suffer from schizophrenia you may not always be able to distinguish between thoughts and reality.

If you suffer from schizophrenia you may experience distressing symptoms such as;

  • hallucinations
  • delusions
  • muddled thoughts
  • changes in behaviour.

There’s no single test for schizophrenia because symptoms may vary so much. A mental health professional, such as a psychiatrist, should be able to help you to reach a diagnosis.

Some people think schizophrenia causes violent behaviour. But this is actually not the case, the cause of any violent behaviour is usually drug or alcohol misuse.

Sufferers have a high risk of suicide due to the distressing nature of the illness, a 5 to 10% suicide rate within ten years of diagnosis this is far higher than the general population.11

If you’re experiencing symptoms of schizophrenia, it important that you do not suffer alone. The earlier schizophrenia is treated, the better.

Causes

While the direct cause of the disorder is still unknown, researchers believe it is linked to the following factors:

  • Genetics

Schizophrenia occurs in 10 percent of people with a first-degree family member, such as a sibling or parent, who have the disorder. Research suggests that genetics may increase the risk of developing schizophrenia.

  • Brain structure and chemistry

Imbalances of certain chemicals in the brain, such as glutamate, serotonin and dopamine, are linked to schizophrenia.

These chemicals control the way in which the brain responds to stimuli.

Research has also shown that there may be small differences in the brain structure of those with schizophrenia – such as decreased grey matter, enlarged ventricles (cavities in the centre of the brain filled with fluid), and increased or decreased activity in some areas of the brain.

  • Environmental factors

As well as genetics, environment also plays a role in the development of schizophrenia. Environmental factors and psychosocial factors in the early years can lead to subtle alterations in the brain that make a person susceptible to developing schizophrenia. Environmental factors later in life can either damage the brain further and thereby increase the risk of schizophrenia, or lessen the expression of genetic or neurodevelopmental defects and decrease the risk of schizophrenia.

It is generally accepted that schizophrenia is caused by a combination of biological, psychological and social factors, as are most mental illnesses.

Symptoms

There are various categories used when describing the symptoms of schizophrenia, these are; delusions, hallucinations, disorganized speech, disorganized behaviour, and “negative” symptoms. The symptom categories are very broad because the symptoms of schizophrenia vary greatly in each person, both in pattern and severity. Not only may you not have all of these symptoms, symptoms may change over time.

Delusions

A persistent and firmly-held idea despite clear and obvious evidence to the contrary. Delusions occur in more than 90% of those who have schizophrenia.

There are various subcategories of delusions such as;

Delusions of persecution – Belief that others, often a vague “they,” are out to get you.

Delusions of reference – A neutral event is believed to have a special meaning and be directly related to you.

Delusions of grandeur – Belief that you are a famous or important figure.

Delusions of control – Belief that your thoughts or actions are being controlled by external forces.

Hallucinations

Hallucinations are sensory experiences that are creations of the mind and are perceived as real and existing in the outside world. Hallucinations are most often experienced as auditory hallucinations – e.g. hearing voices or some other sound. Many times, the voices will be those of someone you know, and often they’re critical, vulgar, or abusive.

Disorganised speech

Schizophrenia can cause you to have trouble concentrating and having stable patterns of thought, this manifests itself externally in the way you talk. Common signs of disorganized speech include:

Loose associations – Rapidly shifting from topic to unconnected topic.

Neologisms – Made-up words or phrases that have meaning only for you.

Perseveration – Repetition of words or phrases.

Clang – Meaningless use of rhyming words.

Disorganised behaviour

Schizophrenia disrupts goal-directed activity, impairing your ability to take care of yourself, be productive at work, and have conversations and relationships with other people. Disorganised behaviour appears as:

  • Difficulty with daily functioning
  • Unpredictable or inappropriate emotional responses
  • Behaviours that seem odd and have no discernable purpose
  • Lack of inhibition
  • Problems with impulse control

Negative symptoms (absence of normal behaviours)

Negative symptoms in schizophrenia refer to the absence of normal behaviours such as:

  • Lack of emotional expression
  • Lack of interest or enthusiasm
  • Apparent unawareness of the environment
  • Inability to carry a conversation

Why is Addiction More Common in those with Schizophrenia?

Schizophrenia and addiction, or substance use disorder, are often co-occurring disorders, an estimated 50 percent of individuals suffering from schizophrenia have a history of substance abuse. Living with schizophrenia is challenging, distressing and often a very isolating experience.

People with schizophrenia often engage in substance abuse as a way to ‘self-medicate’ or alleviate feelings of anxiety and depression related to the hallucinations, delusions, muddles thoughts and behavioural challenged that are a part of schizophrenia. This coping mechanism may provide temporary relief but that doesn’t work for long. Infect schizophrenia often acts as an environmental trigger exacerbating an existing schizophrenia or even triggering in onset.

If substance misuse is present it can be difficult to diagnose schizophrenia or co-occurring disorders, as the symptoms of substance misuse often mimic schizophrenic symptoms.

Nearly half of the people suffering from schizophrenia also present with a lifetime history of addiction or other substance misuse disorders. This rate is far higher than that of the rest of the population. Substance Misuse in schizophrenic people is associated with poorer clinical outcomes and contributes significantly to their morbidity and mortality. Because of this, it is very important to address the two co-occurring disorders, treating one without the other will negatively influence the likelihood of recovery.

In summary, addressing comorbidity of addiction and schizophrenia has important clinical implications for both the prevention and treatment of these disorders and for decreasing overall wellbeing and the likelihood of premature death.

Treatment Options

There are various approaches to the treatment of schizophrenia that seek to reduce psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. And there are good treatment programmes that exist for combatting addiction.

To address the intersecting issues of schizophrenia and addiction you may benefit from a programme of integrated treatment interventions including dual-diagnosis rehab, medications, and therapy.

Rehab

Rehabs can offer rigorous medical, therapeutic, and holistic programmes facilitated by highly skilled, experienced and passionate about recovery.

The programmes on offer for co-occurring schizophrenia and addiction include a blend of:

  • Supported medical approach.
  • 24-hour care from the staff
  • Group therapy
  • One-to-one therapy
  • Specialised therapies, like Cognitive Behavioural Therapy and Dialectical Behaviour Therapy
  • Regular sessions with a key worker
  • An introduction to the 12 steps
  • Motivational Interviewing
  • Skills workshops
  • Holistic treatments
  • Fitness and Healthy Eating
  • Group activities
  • Family Therapy
  • Aftercare

Through engaging with these recovery programmes you will be able to leave behind your addiction.

Some of the skills you will develop are:

  • Living in the present moment – rather than dwelling on things that have happened in the past or worry about things that will happen in the future.
  • Regulating your thoughts and feelings – rather than having an unstable mood you will learn to create peace of mind.
  • Processing feelings- you will learn ways of processing experiences without feeling the need to turn to drugs, alcohol, or any other destructive coping mechanism
  • Relationship and communication skills – you will practice being assertive, non-judgmental and accepting of yourselves and other people.

> Our rehab programme for Schizophrenia and Addiction

Medication

Anti-psychotics are a range of medications that are used for schizophrenia and they can also be used to help other mental health problems such as severe anxiety or depression.

Anti Psychotics aim to help with:

  • Hallucinations
  • Delusions
  • Disordered Thoughts
  • Mood Swings

These medications affect the action of a number of chemicals in the brain, called neurotransmitters such as dopamine.

The newer, second-generation medications are generally preferred as an option for treating schizophrenia because they pose a lower risk of serious side effects than do first-generation antipsychotics.

Second-generation antipsychotics include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

First-generation antipsychotics

First-generation antipsychotics have frequent and significant neurological side effects.

First-generation antipsychotics include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine

Some things to consider are:

  • Antipsychotic medication may relieve you of your symptoms entirely but it’s more likely that they will just make the symptoms less intense and easier to manage.
  • As with any medication, you have to balance the help you get from it, there may be side effects
  • If you have had more than one period of psychotic symptoms and stop the medication, the symptoms often reoccur within 6 months.

In terms of how long you should be taking medication for again, it varies greatly from person to person.

If you have had just one episode of schizophrenia, you have roughly 1 in 4 chance that your symptoms will not return after you get better. So you may well not need to carry on taking an antipsychotic for long.

For most people with schizophrenia, the symptoms will continue or will present again.

Therapy

Once psychosis recedes, in addition to continuing on medication, other interventions are important in terms of co-occurring schizophrenia and addiction.

  • Individual therapy. Psychotherapy can help you to cope with stress and to identify early warning signs of relapse which can help with managing both illnesses.
  • Skills training. Can help you with improving your communication and emotional regulation skills which will enhance your ability to participate in daily activities.
  • Family therapy. This provides support and education to families dealing with schizophrenia and to help everyone to heal individual and in a unit.
  • Vocational rehabilitation this focuses on helping people with schizophrenia and addiction prepare for finding meaningful work.

One-one counselling will give you a safe, confidential, and private place to explore issues including:

  • Addiction
  • Alcoholism
  • Childhood Issues
  • Trauma
  • Self-esteem
  • Relationships
  • Shame & Guilt
  • Grief & Loss
  • Gender
  • Anger Management
  • Stress Management
  • Relapse Prevention
  • Family Issues
  • Body Image

There are many different schools of therapeutic thought and counselling approaches. Your counsellor will ensure your individualized therapeutic journey, which can be adapted as your needs and goals change.

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