Schizophrenia is a severe neurological disorder that causes a break between the individual’s experience and the surrounding world.Although it is often referred to as a form of mental illness, schizophrenia is more accurately defined as a group of serious neurological disorders that alter the individual’s sense of reality. The delusional beliefs, hallucinations, disorganized thoughts, and strange personality traits of schizophrenia can be frightening, both for the individual who experiences them and surrounding loved ones. Because it interferes with thought processes, behaviors, and communication, schizophrenia can leave individuals profoundly impaired in the areas of work, relationships, social interaction, and cognition. Hospitalization, unemployment, homelessness, and suicide attempts are common repercussions of this disease.
Most people who are diagnosed with schizophrenia experience the first symptoms in their teenage years. According to PLOS Medicine, approximately 15.2 persons per every 100,000 suffer from schizophrenia worldwide each year. The early onset of the disorder, combined with the persistence and severity of symptoms, make the social impact of this disease considerable, even though the prevalence is fairly low. The rate of substance abuse among these individuals is higher than in the general population, and drugs and alcohol are often used as a way to cope with the debilitating effects of the disease. Treatment for schizophrenia combined with addiction requires an intensive focus on addressing the symptoms of this serious mental illness, combined with a deep compassion and understanding of the effects of the disease.
Schizophrenia is now seen not as a single neurological condition, but rather a cluster of conditions. Several forms of the disorder have been identified, based on the individual’s dominant symptoms:
- Paranoid: Paranoid schizophrenia is the most common form of the disorder. This subtype is characterized by delusional beliefs about being persecuted, threatened, or controlled by other people or by inhuman forces. Individuals with this type of schizophrenia may obsess over strange conspiracy theories, fear that they are being hunted, or hear voices that tell them to harm themselves or others. They often isolate themselves socially and may be hostile, irritable, or perpetually fearful of others.
- Disorganized: Chaotic thought patterns, strange speech, and odd emotional reactions are the hallmarks of disorganized schizophrenia. Hallucinations and delusions are usually less predominant, and bizarre behaviors are more pronounced. People with this form of schizophrenia may have trouble taking care of themselves, holding a job, or interacting normally with others. Writing, speaking, and other means of self-expression may come across as incomprehensible or extremely eccentric.
- Residual: Individuals who no longer display obvious symptoms of schizophrenia, but who have been affected by the disorder in the past, have residual schizophrenia. Although they may no longer experience profound delusions or hallucinations, people with residual-type schizophrenia may retain less debilitating symptoms of the disease.
- Undifferentiated: This subtype refers to individuals who have symptoms of the disorder that cannot be clearly defined according to the other subtypes. For instance, they may have disorganized speech combined with occasional hallucinations or delusional beliefs, but to a milder degree than individuals who clearly meet the diagnostic criteria.
How to Identify the Signs of Schizophrenia
The word “schizophrenia” comes from two Greek words meaning “split mind.” The term was coined by Professor Paul Eugen Bleuler, a psychiatrist who studied the disease. According to the Indian Journal of Psychiatry, Bleuler defined schizophrenia as a splitting of the processes involved with emotion, cognition, behavior, and communication. People with schizophrenia may experience the world in ways that are not reflected in their behaviors, and they often lack the ability to communicate those experiences to other people in a way that can be understood. Delusional beliefs, hallucinations, and paranoid fears may make them too frightened to communicate their experiences to others or even to take part in mainstream society.
Schizophrenia affects every aspect of an individual’s mind and personality. One of the most obvious warning signs 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 sensory experience, thoughts and learning, or social interaction and communication:
- Sensory symptoms: Visual hallucinations (seeing things that aren’t there) or auditory hallucinations (hearing voices telling the individual what to do or other sounds that aren’t audible to others).
- Cognitive symptoms: Inability to understand or utilize language in comprehensible ways, disorganized thinking, difficulty learning in conventional ways, and false beliefs about grandiose achievements or persecution
- Behavioral symptoms: Self-isolation and social withdrawal, neglect of personal hygiene, fear of eating or drinking, fear of touching or being touched by other people, pressured speech, lack of motivation, loss of interest in jobs or favorite activities, inability to relate to others in socially accepted ways, wild or unpredictable behavior, and lack of impulse control
- Emotional symptoms: Loss of emotional affect, flat facial expression, emotional responses that don’t make sense, lack of empathy with others, and inexplicable mood changes
According to the National Alliance on Mental Illness, schizophrenic symptoms appear for the first time in most people in their teens or 20s; however, the average person with schizophrenia does not receive help for at least 8.5 years. Schizophrenia is more common among males than females, and symptoms often manifest during key transitions or losses in a young person’s life, such as going to college, experiencing the loss of a close relative, 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 handwriting
- Sudden loss of interest in favorite activities or friendships
- Neglect of grooming and hygiene
- An intense focus on negative or destructive thoughts
- Isolation from friends and family
- Loss of ability to control impulses
- Lack of awareness in the surrounding world
- A flat 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.
Because substance abuse is often a side effect of schizophrenia, a person who shows the red flags of serious mental illness should also be evaluated for chemical abuse or dependence.
Understanding the Roots of Schizophrenia
Neurologists, psychiatrists, and biologists are still researching the origins of schizophrenia. There are several popular theories about the roots of this disease; however, many researchers agree that in any given person, schizophrenia may come from a combination of sources:
- Brain chemistry: Imbalances in certain neurotransmitters, or chemicals that allow communication between the brain, nerves, and vital organs, are involved in schizophrenia. In particular, dopamine and glutamate have been identified as neurochemicals that play a role in the thought patterns and behaviors of people with this disorder. According to the Proceedings of the National Academy of Sciences, one of the most popular theories about the origins of schizophrenia is the dopamine hypothesis, which associates schizophrenia with higher than normal levels of dopamine, a neurotransmitter that affects mood, cognition, sensory experience, metabolic activity, and other important functions.
- Brain structure: Imaging studies of human brains have been used to identify structural differences between the brains of individuals with schizophrenia and those without the disorder. These structural differences frequently occur in the frontal lobe.
- Heredity: The neurobiological features that contribute to the risk of developing schizophrenia may also have a genetic component. The National Alliance on Mental Illness states that several genes, rather than a single gene, are involved in this complex disorder, which is 10 percent more likely to occur among close relatives and 50 percent more likely in the case of twins.
- Environmental factors: A tendency toward schizophrenia may begin even before birth. Complications with pregnancy, maternal exposure to drugs or toxins, and fetal malnutrition may contribute to schizophrenia. Later in life, some researchers propose that viruses, industrial chemicals, chaotic home environments, or traumatic life experiences can set the stage for schizophrenia.
Substance abuse does not cause schizophrenia, but the chronic, excessive misuse of alcohol or drugs can increase the frequency and severity of psychotic episodes. In particular, drugs like cannabis, LSD, and other hallucinogenics have been linked with schizophrenic episodes. Stimulants like cocaine have also been implicated in the psychotic thought patterns and hallucinations of schizophrenia.
Statistics on Schizophrenia and Substance Abuse
The rate of substance abuse is 50 percent higher among individuals with schizophrenia than among the general population, according to Schizophrenia Bulletin. The journal identifies the most commonly abused legal and illegal drugs among schizophrenic patients as alcohol, nicotine, cocaine, and marijuana. Substance abuse can intensify the severity of schizophrenic symptoms, increase the number of psychotic episodes, and increase the risk of outcomes like hospitalization, incarceration, and suicide attempts.
Although schizophrenia can have a dramatic effect on an individual’s thoughts, speech, and behavior, it is not always easy to identify these effects as signs of schizophrenia, especially in people with substance use disorders. Alcohol or drug abuse can mask the symptoms of schizophrenia, and vice versa. Substance abuse and schizophrenia may have the following symptoms in common:
- Unpredictable moods and behaviors
- Withdrawal from social situations
- Delusional beliefs about oneself and others
- Auditory or visual hallucinations
- Disorganized thoughts
- Rapid, pressured speech
- An odd or inappropriate emotional affect
- Poor judgment and high-risk behaviors
- Lack of concentration
The side effects of chemical addiction can mask the symptoms of schizophrenia; by the same token, the symptoms of schizophrenia may make it difficult to identify a problem with drugs or alcohol. Treatment of schizophrenia combined with a substance use disorder — a condition known as a dual diagnosis — is complicated by the paranoia, disordered thought patterns, and communication difficulties caused by schizophrenia.
People with schizophrenia may use alcohol or drugs as a way to cope with their symptoms, which can be extremely disturbing and emotionally painful.
Alcohol and marijuana, both central nervous system depressants, can have a sedative effect on an overactive mind fraught with hallucinations or delusional beliefs. 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.
Getting Help for a Loved One
Because of the delusional beliefs, emotional blunting, and chaotic thought processes of schizophrenia, talking to a loved one about this disorder can be extremely challenging. It is important to remember that although schizophrenia is a chronic, usually lifelong disorder, its symptoms are treatable, and its negative consequences are preventable. With the right combination of medications, psychosocial services, and recovery services, people with schizophrenia can reduce their behavioral and neurological symptoms while learning how to overcome the effects of drug or alcohol abuse.
The ideal time to start a conversation with a loved one who displays signs of schizophrenia is early in the disease process, when symptoms are not acute and the individual is not under the influence of alcohol or drugs. Intervening in addictive behaviors may be difficult or even impossible if the individual is in the midst of a severe psychotic episode. In extreme cases, hospitalization may be required to stabilize the individual and bring symptoms to a manageable level before the recovery process can begin. The transition can then be made from an acute hospital setting to a detox center or inpatient rehab program.
The Harvard Review of Psychiatry states that early detection and treatment of schizophrenia increase the chances of remission, or a significant relief of symptoms. Studies of schizophrenic patients undergoing treatment show that the sooner psychotic episodes are addressed, the greater the likelihood of a positive outcome. Although it may be uncomfortable or embarrassing to talk to loved ones about treatment, getting them into rehab promptly may make the difference between whether or not treatment is effective.
Approaches to Treatment
Although psychiatric medication cannot cure schizophrenia, it can make it easier for these individuals to function in society and lead healthier lives. 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.
Older antipsychotic medications, known as “typical antipsychotics,” have been used since the mid-20th century to improve treatment outcomes for schizophrenic patients. These medications include:
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
- Chlorpromazine (Thorazine)
- Loxapine (Loxitane)
- Perphenazine (Etrafon)
- Trifluoperazine (Stelazine)
The newer medications used to treat schizophrenia, also known as “atypical” or “second generation” antipsychotics, generally have milder side effects — for example, the newer medications are less likely to cause abnormal body movements — and act on the brain in different ways. Some of the most widely used atypical antipsychotics include:
- Quetiapine (Seroquel)
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Lurasidone (Latuda)
The consequences of schizophrenia can leave a person’s life chaotic and disorganized. Psychosocial interventions may include case management, family therapy, support groups, occupational counseling, and financial or legal resources. To address the psychological and behavioral disturbances of schizophrenia, and the maladaptive coping mechanisms of addiction, treatment must include a combination of intensive mental health services and recovery services, such as the following:
- Individual therapy: One-on-one therapy sessions with a licensed mental health professional
- Group therapy: Therapeutic meetings in which individuals share their experiences and discuss coping strategies in recovery
- Family Systems Therapy: An approach to family recovery that treats the illness as a condition that affects the entire household, not just the individual patient
- Cognitive Behavioral Therapy (CBT): A modality that teaches clients how to transform self-defeating thought process and behaviors into more positive, self-affirming ones
- 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
Substance abuse treatment can take place on an inpatient or outpatient basis. Intensive residential treatment is often recommended for individuals with a dual diagnosis of schizophrenia and chemical dependence. In the structured environment of an inpatient facility, clients can focus exclusively on their recovery without the distractions and triggers of the outside world. After completing an intensive residential program, the client can then move on to a partial hospitalization program (PHP) or outpatient treatment.
Extensive support will be required as the client makes the transition from rehab back to the community. Sober living programs provide a safe, supportive setting where individuals in recovery can practice their coping skills and prepare to integrate back into the community.
Looking to the Future
Even though schizophrenia and addiction are considered to be chronic, progressive illnesses, many individuals with these disorders have been able to live productive, satisfying lives. The key to reaching a state of remission in both conditions is an integrated program that devotes equal energy and resources to mental health treatment and substance abuse recovery. Each individual in recovery has unique needs, but the social and cognitive obstacles posed by schizophrenia can be especially challenging. Treatment should be tailored to the individual’s needs and must support the client at every stage of the rehab process. From medical detox through rehab and aftercare, a multidisciplinary team of supportive professionals should provide the necessary motivation and resources for recovery.