lifestyle issues
 
 
  
Schizophrenia and Alcohol Abuse or Dependence
 
 
Co-morbidity
 
The disease schizophrenia is often complicated by co-morbid illnesses which include other mental illnesses, medical illness, mental retardation and substance abuse.  Substance abuse disorders are the most common and relevant co-morbid conditions.  Of these, nicotine is the substance that is most commonly abused, followed by alcohol.1  Alcohol, unlike some abused substances, is readily available and legal.
 
Alcohol abuse (or dependence) is the second most common co-morbid disorder in people with schizophrenia.  The association between the two diagnoses may be related to biological and psychosocial factors.
 
People who have problems with alcohol use and schizophrenia are more likely to have social, legal and medical problems than other people with schizophrenia.  Alcohol use also complicates the course and treatment of schizophrenia.
 
 
Factors That Influence the Incidence of Co-morbid Disorders
 
People with schizophrenia likely use alcohol for the same reasons that people without the illness do.  The high incidence of co-morbid substance abuse seems to be shaped by a complicated group of factors.2  They include biological, psychological and socioenvironmental factors.
 
People with schizophrenia may use alcohol to “self-medicate” symptoms or reduce perceived side effects.  The abnormalities in the brains of people with schizophrenia, especially those that involve the neurotransmitter dopamine, may add to the reinforcing effects of abused substances.  This may explain the high incidence of tobacco use in people with schizophrenia, as nicotine increases dopamine effects in some regions of he brain.  The reinforcing effects of alcohol may involve a number of neurotransmitters.
 
People with schizophrenia have impaired judgement and impulse control and so may be more likely to demonstrate behavioral abnormalities when they use illicit substances or alcohol.  These behaviors may increase the chances that they receive a diagnosis of substance abuse in the first place.
 
Psychological factors may play a role.  People with schizophrenia may use alcohol to treat the negative mood states that can be associated with financial difficulties, restricted opportunities, the stigma associated with their illness and its treatment, especially hospitalizations and side effects, and even boredom.  Alcohol use may also allow them to be a part of a social network.
 
 
Treatment
 
In the past, treatment for schizophrenia and substance abuse disorders were separate entities.  This has changed in recent decades with the advent of integrated treatment.  People who suffer from both disorders may now be treated in dual disability treatment programs.  They may be inpatient, outpatient, or part of another program such as ACT (Assertive Community Treatment).
 
Dual-disability clients usually experience four stages of treatment:
 
  1. Engagement:  where patients come to trust individuals who may be involved in their treatment.  
  2. Persuasion:  where they become motivated for treatment.  
  3. Active treatment:  which involves the acquisition of the knowledge, skills and support necessary to manage their illness and begin recovery.  
  4. Relapse prevention:  the formulation and execution of a plan to prevent relapses.
 
 
Fetal Alcohol Exposure
 
A number of factors may influence our risk for developing schizophrenia.  One may be a mother’s use of alcohol during her pregnancy.  This may alter dopamine activity in the fetus which may increase the risk for developing schizophrenia later in life.
 
Mary L. Schneider, a University of Wisconsin professor of occupational therapy and psychology, reported that adult monkeys who were exposed to even small quantities of alcohol in utero (while in the womb) suffered significant abnormalities in the development and functioning of dopamine neurotransmission later in life.3  These effects may become evident years later.  This study suggested that there is no “safe” amount of alcohol use, nor is there a “safe” time that alcohol may be used during pregnancy.
 
 
Summary
 
  1. 1.Co-morbid alcohol abuse or dependency is common in people with schizophrenia.  
  2. 2.It represents the second most common form of co-morbid substance abuse, after tobacco abuse.  
  3. 3.It is responsible for significant complications that involve the course of treatment of this illness.  
  4. 4.Both biological and psychosocial factors influence the relationship between the two diagnoses.  
  5. 5.The increased risk for co-morbid substance abuse may be related to brain abnormalities that involve the neurotransmitter dopamine.  
  6. 6.This risk may also be related to the impairments of judgement and impulse control characteristic of people with schizophrenia.  
  7. 7.Integrated treatment for dual-disability clients is now available in several forms.  
  8. 8.Research involving monkeys suggests that maternal alcohol use may increase an individual’s risk for developing schizophrenia later in life.  
  9. 9.That same research suggests that there is no safe amount or timing of alcohol use.
  10.  
 
1 Cuffel BJ. Comorbid substance use disorder: Prevalence, patterns of use, and course. In: Drake, R.E., and Mueser, K.T., eds. Dual Diagnosis of Major Mental Illness and Substance Disorder: Recent Research and Clinical Implications. San Francisco: Jossey-Bass, 1996. pp. 93-105.
2 Mueser KT, Drake RE, Wallach MA: Dual diagnosis: A review of etiological theories. Addictive Behaviors 23:717-734, 1998.
3 Schneider ML.  Alcololism:  Clinical and Experimental Research Sept. 15, 2005  University of Wisconsin-Madison
 
 
(Sources:  The author’s knowledge base, unless otherwise noted.)
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