Schizophrenia and Substance Abuse

Dealing with the reality of a schizophrenia diagnosis can be both frightening and devastating. With the most common symptoms being virtually debilitating, it is easy to see why those suffering with schizophrenia may reach out for anything to make themselves feel better or help them lead the normal life they may have once had.

The use and abuse of drugs, alcohol and nicotine by schizophrenics is very high. According to one study, 16% of schizophrenics have drug problems and 32% of schizophrenics have alcohol problems 1. Sadly, those who have schizophrenia and also abuse drugs and alcohol increase their chances of being homeless at one point or another. Using substances often interferes with the very treatment they need to live the most independent and healthy life possible, and can increase their social isolation.

Abuse of drugs and alcohol typically exacerbates the symptoms of schizophrenia symptoms. Symptoms such as hallucinations or delusions, paranoia, confusion, difficulty interacting socially will only worsen with drugs and alcohol. Also, their thought processes will usually become more disorganized and illogical.

Antipsychotic medications which are used to effectively control the debilitating effects of the illness may interact negatively with certain street drugs. Substance abuse may also increase the risk of violent behavior, as well as the likeliness of an initial psychotic break or the recurrence of psychotic episodes.

Schizophrenics who abuse alcohol or drugs have a much greater risk of non-compliance with their treatment plan. They will be more likely to stop taking their medication, and less inclined to continue with other modes of treatment. As mentioned above, substance abuse also significantly increases the chance the schizophrenic will become homeless at some point in their life time.

Smoking can also be more harmful for schizophrenics than for those who do not have a mental illness, for a variety of reasons. Nicotine has been proven to interfere with some antipsychotic drugs, causing them to break down more quickly or increasing the risk for side effects such as tardive dyskinesia. This means the schizophrenic smoker may need higher doses of the medication for it to be effective 2.

Studies have shown people with schizophrenia smoke at a much greater rate than the general population. Smokers in the general population consist of approximately 25% to 30% 3. For schizophrenics, the rate is much higher, at around 62% 4. There are many studies exploring the reasons why so many schizophrenics use nicotine.

For those with schizophrenia, turning to these forms of self medication gives a false sense of relief. The temporary alleviation of the confusion, despair and unpredictability of schizophrenia is not the safest route. Expert medical and psychiatric care is the best hope for someone who has schizophrenia in terms of living a full and productive life.

written by Dr. Cheryl Lane, PsyD


  1. Spotting the Sings of an Acute Schizophrenic Episode
  2. Antipsychotics: Antipsychotics, other drugs and driving
  3. "Schizophrenia - What About Substance Abuse," NIMH
  4. Citation bias in reported smoking prevalence in people with schizophrenia

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