Schizophrenia is a mental health condition that has long been the subject of myths of multiple personalities and urban legends, but it is a real illness that affects real people. Its characteristics may be widely misunderstood, and its effects are often confused with those of similar mental health issues, but millions of people suffer as a result of having it. Many of them also deal with substance use disorders. How a drug addiction affects schizophrenia can complicate an already delicate situation, but treatment options exist and they can save lives.
Schizophrenia vs. Psychosis
One of the biggest problems confronting individuals and caregivers is that schizophrenia is probably the most misunderstood mental health illness, according to The Independent. This is partially because, as MedScape points out, schizophrenia’s particular effects on thought processes and behavior are shared (or resemble) those caused by other medical conditions. Patients who have bipolar affective disorder may exhibit schizophrenia-like symptoms during a manic period, and patients who have hypoglycemia or hyperglycemia can become easily confused and irritable, which can be mistaken for signs of schizophrenia.
Explaining what schizophrenia is sheds some light on the confusion. Schizophrenia is a mental illness that causes psychosis in its sufferers. Medical News Today explains that psychosis is a symptom of mental illness and not mental illness itself. One mental illness that can cause psychosis is bipolar disorder; the other is schizophrenia. Yet others include major depression, dementia, and borderline personality disorder.
Psychosis can also be the result of extreme amounts of stress, a severe lack of sleep, or trauma, such as a brain injury. Some people who use, or are withdrawing, from certain drugs may go through periods of psychosis. Psychosis can be part of schizophrenia, but it can be caused by a number of other factors that are not related to schizophrenia, hence the confusion.
If schizophrenia causes psychosis, what is psychosis? People who have psychosis suffer from a break in how they perceive reality; they may experience things and take them for real when they are not. This falls into two types:
- Hallucinations (hearing or seeing stimuli that do not exist)
- Delusion (believing things that are not based in reality)
Psych Central writes that in order for a doctor to reach a diagnosis of schizophrenia, a patient must have the delusion and hallucinations (as well as other milder symptoms, such as notable changes in behavior and personality, as well as difficulty focusing and thinking) for a month, at a minimum; symptoms would additionally have to persist for at least six months
Schizophrenia tends not to develop in people until they are in their 20s; men might see their first symptoms in their early- to mid-20s, and women will develop symptoms closer to their 30s. It is rare for schizophrenia to emerge in people in their adolescence. The first symptoms tend to be the milder ones, such as expressing strange or unusual beliefs, but ones that are not delusional. Speaking patterns may hint at a problem in forming thoughts, but patients in this stage of the disorder can still be understood. Behavior tends to be unusual (such as speaking to oneself in public), and abnormal perceptions (like thinking another person is present, when this is not the case) may be experienced, but this would still stop short of an actual schizophrenia diagnosis.
What would be required to cross that threshold is if the patient’s daily life and wellbeing are significantly impacted by the symptoms, which would go from being mildly strange to being deleterious and potentially harmful. Job and academic performance, interpersonal relationships and self-care should be well below the level that they were, before the symptoms developed, for the right kind of treatment to be diagnosed.
Causes and Origins of Schizophrenia
What could cause a condition like schizophrenia? The National Alliance on Mental Health explains that it is impossible to identify just one factor that might determine whether or not a person goes on to become a schizophrenic, but there are some usual areas that doctors might look at:
- Environment: The Schizophrenia Bulletin journal writes that if a person is exposed to disruptions in their prenatal development (such as viruses or malnutrition), especially in the first and second trimesters, that person may be at risk for developing schizophrenia in their adult life. Stressful situations, such as grief, trauma, physical illnesses, and difficult life adjustments, can exacerbate schizophrenia symptoms. During such periods, people with schizophrenia are at an increased risk of experiencing episodes of psychosis, as well as indulging in risky behavior, such as suicide attempts.
- Genetics: Like a number of mental health issues, there is a very complicated overlap between genetics and influences from the environment, which can explain one of the reasons why schizophrenia is so widely misunderstood. Only 1 percent of the general population has schizophrenia, but the risk is greatly increased if there is a family history of the condition, so much so that 10 percent of people who have an immediate family member with the disorder will go on to develop it themselves. If a person has an identical twin with schizophrenia, there is a 50 percent chance of the person eventually exhibiting signs of schizophrenia.
- Neurochemistry: The human brain communicates by sending out chemical information from one nerve cell (or neurons) to another. It is how the brain carries out everyday functions of moving, speaking, listening, thinking, eating when hungry, and regulating literally every system of the human body. But with schizophrenics, their brain chemistry is out of balance, with some key neurotransmitters not communicating the way they should.
Further research has discovered that the brain structures of people with schizophrenia are different than the structures of people without the condition. Schizophrenics have large ventricles, fluid-filled spaces at the center of the brain; similarly, they have less gray matter (tissue of the brain and spinal cord), and other areas of the brain have varying levels of activity, when compared to people who do not have schizophrenia.
Brain tissue also shows changes as a result of the development of schizophrenia. The National Institute on Mental Health writes that there are small differences in the location or structure of some brain cells, which are formed before birth. As the brain develops, those differences may cause problems in the neurochemical communication of the brain sending messages through itself to the central nervous system and the rest of the body. This would also explain why schizophrenia symptoms do not develop until after puberty and adolescence, as the changes caused by puberty may be the catalyst that triggers the symptoms, which don’t emerge until after the brain’s changes have fully matured.
Drug Addiction and Schizophrenia
Lastly, a growing body of research has pointed to a connection between the abuse of certain controlled substance during teenage years and adolescence, and an increase in the risk of schizophrenia in the onset of adulthood.
One such drug that may affect schizophrenia is marijuana. The journal of Current Pharmaceutical Design wrote in 2012 that “cannabis use is associated with an increased risk for psychotic disorder,” but cautioned that other factors have to be involved because most marijuana users do not develop psychosis. People who have a psychological risk for psychosis are the most susceptible to display symptoms of psychosis after using cannabis, researchers wrote, also mentioning that multiple studies show people who have a family history of psychosis “have an increased sensitivity to the effects of cannabis.” The researchers concluded that there exists a biological connection between using marijuana and a genetic vulnerability to schizophrenia in patients where such a vulnerability exists.
In another article in Current Pharmaceutical Design, partially entitled “Effects of Cannabis Use on Human Brain Structure in Psychosis,” researchers wrote that patients who have psychosis and who are at risk for psychosis “might be particularly vulnerable to brain volume loss due to cannabis exposure.”
The main active ingredient in marijuana is called tetrahydrocannabinol, or THC. When a person consumed a marijuana-based product, the THC hits two different parts of the brain: the prefrontal cortex and the hippocampus, both of which are very important in how decisions are made and how the brain accesses long-term memories. The journal of Neuropsychopharmacology writes that these are the same parts of the brain that show signs of corruption and damage when schizophrenia develops. When mentally healthy people consume a marijuana-based product, the effect of the THC on their brain temporarily mimics the confusion and disorganization in the prefrontal cortex and hippocampus that schizophrenia enacts on a permanent basis.
Given time, the effects of marijuana on the prefrontal cortex and hippocampus could theoretically increase the possibility that schizophrenia itself will develop in the patient, especially if other risk factors for the condition are also present.
What makes the question of drug addiction affecting schizophrenia of great concern is that people who are diagnosed with the condition tend to consume more drugs and alcohol than the general population, according to the American Journal of Psychiatry, and marijuana is one of the most commonly abused drugs by people with schizophrenia (the other two are alcohol and nicotine).
Schizophrenics tend to have higher rates of homelessness, poverty, social isolation, and even incarceration, which can increase the chances of using alcohol or drugs to self-medicate their resultant stress and depression.
This may especially be the case if people are not receiving psychiatric treatment for their condition.
Schizophrenia, Drug Addiction, and Treatment
Treating a schizophrenia condition affected by drug addiction is not easy, because it is important to see the difference between psychosis induced by controlled substances and the psychosis that arises from the schizophrenia. This can be made easier by guiding the person through detox, so drugs and alcohol can eventually be removed from the equation.
Schizophrenia and drug addiction together can greatly complicate the recovery process, so the best form of approach is integrated treatment. This method addresses both the addiction and the schizophrenia at the same time and focuses on the connection between the two, as the key to snapping the chain.
For this to happen, integrated treatment for co-occurring disorders will use:
- Psychiatric medication (such as clozapine)
- Anti-addiction medication
- Motivational Enhancement Therapy (strengthening the motivation to quit drugs and building a plan for changing bad behavior and developing healthy goals)
- Cognitive Behavioral Therapy
- Stress reduction therapy (e.g., yoga or meditation)
- Peer group or 12-Step programs
- Family support and counseling
Living with Schizophrenia
In the same way that there is no “cure” for drug addiction, there is no cure for schizophrenia. But lifelong treatment, therapy and recovery programs, as well as lifestyle changes, can help a client with a co-occurring substance abuse and schizophrenia disorder manage the condition. Encouragement and solidarity from friends and family is vital. The Huffington Post writes that 89 percent of people diagnosed with schizophrenia said that not getting support had a negative impact on the quality of their lives, leading to the severity of their symptoms increasing and affecting their ability to stay at their jobs or return to work following treatment.
When things come together, however, the road ahead is much clearer. A schizophrenia patient writes in The New York Times of how “the importance of routine” has aided him in the eight years of his recovery, helping him achieve stability, health, and recovery. The same patient also explains how his schizophrenia threatens to sabotage making friends, as there is a part of him that is never entirely sure if the friendships are genuine; but in finding communities (in his case, at a coffee shop), bonds are inevitably forged.
Similarly, Scientific American says that a schizophrenia diagnosis does not have to be the end of the world. While it was traditionally believed that having schizophrenia would result in nothing but a “steady downhill progression,” development in treatment methods (like Cognitive Behavioral Therapy, which Schizophrenia Bulletin wrote is an effective model of treatment for the psychotic symptoms of the condition) have led to clients experiencing significant improvements in their daily lives. People with schizophrenia can have steady jobs, maintain families and social circles, and enjoy “relative” normalcy.