Substance abuse disorders are conditions in which the use of substances of abuse such as alcohol, illicit drugs, tobacco, etc. lead to physiological, functional, or clinical impairment of a body process. The most commonly abused substances are hallucinogens, cannabis (marijuana), opioids, tobacco, stimulants, and sedatives. Even though substance abuse is not limited to a certain population group, recent studies show that patients with schizophrenia have a higher tendency to abuse drugs especially alcohol and cigarette ( Dickey et al., 2000 ). Schizophrenia is a mental illness that clinically interferes with a person’s ability to control his or her emotions, to think clearly, or make meaningful decisions. The cause of schizophrenia is not known, however, clinicians have linked the condition with the environment, genetics, substance use, and changes in the chemical nature of the nervous system.
In the United States, substance abuse is pandemic. Approximately 20 million adults use illicit drugs and around 8 million of this population develop substance use disorders which costs the families and American government billions of money annually. The substances commonly abused are tobacco, alcohol, and marijuana. Patients with schizophrenia experience psychotic episodes, bizarre distortions, and split mind from outside world ( McCarthy, 2016) . Clinicians believe that incidence of alcohol use is high among patients of schizophrenia because they try to suppress the symptoms of the disease such as auditory hallucinations, delusional beliefs, and distorted physical appearance using alcohol.
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In order to explain why alcohol addiction is the most common comorbid condition in schizophrenia patients, psychologists have come up with a number of theories to explain the elevated prevalence. For example, the accumulative risk factor hypothesis which argues that patients with schizophrenia have poor social and cognitive exposure and therefore, lead a lonely life and loneliness is a risk factor to substance abuse ( Green et al., 2007 ). Also, anti-psychotic medications used to manage schizophrenia have untoward side effects and therefore, the theory of self-medication proposes that patients with schizophrenia use drugs and alcohol to reduce the effects of antipsychotic drugs. Also, patients not on medication can drink alcohol as a maladaptive way of coping with stress associated with schizophrenia.
Patients with schizophrenia and substance use disorder develop comorbidity status which has been shown to be difficult to manage. Such a condition requires an integrated medical approach which is not only expensive but difficult to achieve. A combination therapy for schizophrenia and substance abuse disorder has higher risks of developing negative outcomes compared to single therapy for schizophrenia. Apart from providing the patient with antipsychotic drugs, psychotherapy, and counselling, dual diagnosis is key in the comorbid status of these two conditions ( Green et al., 2007 ). Therefore, co-administration with psychiatric medication has been shown to show great recovery outcomes. According to a research study conducted Barbara, Azeni, and Sederer in their article Schizophrenia, substance use disorders and medical co-morbidity , treatment costs of adults with both schizophrenia and substance use disorder is higher than that of patients with schizophrenia only ( McCarthy, 2016) .
A well informed treatment of the comorbid status of both substance use disorder and schizophrenia involves both pharmacological and non-pharmacological treatment. Non-pharmacological treatment involves psychological interventions such as support at work and family, assertive community treatment, and motivational components ( McCarthy, 2016) . Recovering patients are put in support groups and individual counselling sessions which help them resist substance and direct their compulsions to something useful in the society. Pharmacological treatment targets the specific conditions. For patients with comorbid states, atypical antipsychotics such as clozapine are used to manage symptoms of schizophrenia because they reduce psychotic symptoms that are severe in these patients. Adjunctive agents such as bupropion are helpful in schizophrenic patients who are addicted to smoking cigarettes ( Futures of Palm Beach, 2018 ). In alcoholics, naltrexone helps to reduce addiction to alcohol in patients with schizophrenia. Today, studies are underway targeting anticonvulsants like topiramate and glutamatergic agents like acamprosate which have shown beneficial effects in schizophrenic patients struggling with alcoholism.
Currently, scientists have not been able to prove if schizophrenic symptoms can lead to substance use other than the postulated hypothesis that links the two conditions ( Dickey et al., 2000) . However, substance use is known to cause negative outcomes in patients suffering from schizophrenia which leads to high costs of medication and individual suffering. Therefore, future studies should focus on proving the hypothesis or coming up with reasons why high rates of substance use are common in patients with schizophrenia.
References
Dickey, B., Azeni, H., Weiss, R., & Sederer, L. (2000). Schizophrenia, substance use disorders, and medical co-morbidity. The journal of mental health policy and economics , 3 (1), 27-33.
Futures of Palm Beach. (2018). Schizophrenia and Substance Abuse: Treatment for Co-Occurring Disorders. Retrieved from https://www.futuresofpalmbeach.com/co-occurring-disorders/schizophrenia/
Green, A. I., Drake, R. E., Brunette, M. F., & Noordsy, D. L. (2007). Schizophrenia and co-occurring substance use disorder. American Journal of Psychiatry , 164 (3), 402-408.
McCarthy, A. G. (2016). Get the Facts on Substance Abuse. Retrieved from https://drugabuse.com/library/get-the-facts-on-substance-abuse/
