Are Schizophrenia And Alcohol Consumption Related?

According to an Epidemiologic Catchment Area study, 33.7% of individuals diagnosed with schizophrenia or a related disorder may also meet the criteria for an alcohol use disorder diagnosis, although updated research may be needed. Statistics like these suggest that there may be a significant, though complex, connection between schizophrenia and alcohol consumption. Various factors likely contribute to the complexity of the relationship between these disorders, some of which could cause higher symptom severity or likelihood of disorder co-occurrence. Understanding these disorders and how they interact may be helpful for those seeking treatment, which typically involves medication, therapy, and other forms of support.

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What is alcohol use disorder?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes alcohol use disorder (AUD) as a medical condition that may impair an individual’s ability to control or stop the use of alcohol. This lack of control may have adverse occupational, social, and health-related consequences. The severity of AUD is often classified as mild, moderate, or severe, which may be determined by the number of criteria an individual meets. A medical professional may assess severity by asking questions that pertain to an individual’s frequency and duration of drinking, unsuccessful attempts to quit, how drinking has interfered with their life, and whether drinking has led to potentially dangerous situations. In addition, a medical professional may be able to discuss how AUD can interact with other disorders, such as schizophrenia. 

What is schizophrenia?

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), schizophrenia falls under the disorder class of “schizophrenia spectrum and other psychotic disorders.” This mental health disorder may present with positive symptoms (those that have the potential to change thoughts and behaviors), such as the following:

• Hallucinations: Sensory experiences (such as those that affect sight, hearing, taste, touch, and smell) that only exist within the mind of the individual with schizophrenia.
• Delusions: Beliefs that may be based on illogical or unrealistic evidence, such as being the subject of a murder plot or being spoken to directly through the radio or television.
• Disorganized speech: Difficulty keeping track of the subject of a conversation, typically due to disordered or confused thought patterns; this may make effective communication difficult.
• Catatonic behavior: In some cases, individuals with schizophrenia may have reduced voluntary motor function, which may result in an inability to move
• Negative symptoms: Negative symptoms might include difficulty expressing emotions and a lack of motivation.

Individuals with schizophrenia may also experience negative symptoms, such as difficulty expressing emotions and a lack of motivation. 

Schizophrenia may impact an individual's ability to function in a variety of areas of their life, including at work, in their interpersonal relationships, and in their self-care routines. In many cases, a doctor or medical professional may have to rule out other disorders with potentially similar symptoms, such as schizoaffective disorder or bipolar disorder with psychotic features. These professionals may also check that symptoms cannot be attributed to the effects of a medical condition or a specific substance, such as alcohol. 

Can alcohol consumption cause schizophrenia?

Symptoms of schizophrenia and alcohol consumption

In addition to the potential for alcohol-related psychosis, research suggests that AUD may contribute to worse outcomes for those experiencing schizophrenia. For example, alcohol use can lead to behaviors and risk factors that could worsen schizophrenia symptoms, such as those listed below: 

• Treatment (including proper use of medication or therapy attendance) 
• Violent behavior
• Higher risk of hospitalization
• Higher risk of homelessness or incarceration

Why the rate of alcohol consumption is higher in people with schizophrenia 

While the exact cause of higher AUD rates in individuals with schizophrenia may not be known, researchers have proposed several potential contributing factors, although more recent research could be beneficial. These contributing factors were separated into biological factors and psychological/socio-environmental factors. 

Biological factors

Researchers have identified three possible biological factors that could contribute to higher rates of substance use disorder in individuals with schizophrenia. 

1. Alcohol and other substances are used as a form of self-medication. Individuals with schizophrenia may attempt to alleviate their symptoms through substance use, though this behavior may worsen symptoms over time. However, research may not support this view for several reasons, such as the tendency for alcohol misuse to precede schizophrenia and the indication that specific substances were not chosen for the self-medication of specific symptoms.
2. Underlying abnormalities in the brain that can characterize schizophrenia may facilitate the positive reinforcing effects of substance use. It is commonly thought that the dysregulation of dopamine may serve as the neurological basis for not only these reinforcing effects but also for schizophrenia itself. To support this, researchers cite the frequency with which individuals with schizophrenia use certain substances (such as nicotine), as they may increase dopamine levels or transmission. The reinforcing effects of alcohol specifically can involve multiple systems of neurotransmitters, though researchers note the mechanisms involved may not yet be defined. 
3. The final hypothesis suggests that individuals living with schizophrenia may be more vulnerable to the negative psychosocial effects of substance use. This may be due to the way that schizophrenia symptoms can impair social judgment, impulse control, and the ability to think clearly. Because of these effects, the behavior of individuals with schizophrenia may be significantly impacted by the use of relatively small amounts of psychoactive substances. 

Psychological and socio-environmental factors

In addition to biological factors, certain socio-environmental and psychological factors may also contribute to AUD and schizophrenia co-occurrence rates. For example, some individuals with both AUD and schizophrenia have reported that they have used substances to alleviate dysphoria related to mental illness, boredom, a lack of opportunities, and poverty. 

Some people with schizophrenia have also reported that alcohol can provide ways to socialize. While those with schizophrenia may struggle with limited social, vocational, and recreational opportunities, some may see substance use as a way to develop a social network. However, it is often far more beneficial to seek more viable and proven approaches to socialization and treatment. 

Treating mental health conditions like alcohol use disorder and schizophrenia

While AUD and schizophrenia usually require separate treatment plans, some treatment modalities may function for both disorders. While historically, substance misuse and mental health conditions may have been treated separately, integrated treatments could be beneficial. These typically include those that emphasize outreach, comprehensiveness, and stage-wise treatment. Individuals experiencing both AUD and schizophrenia may pass through four distinct treatment stages: 

1. Engagement, where a trusting relationship with treatment is created
2. Persuasion, where the motivation to manage these disorders is developed
3. Active treatment, during which an individual may develop skills and find support to manage their illness and recover
4. Relapse prevention, during which an individual may learn strategies to avoid (or minimize) the potential effects of relapse

Treatment regimens may include the use of certain medications, which must be prescribed by a psychiatrist or doctor. Integrated treatments may also involve the use of psychotherapeutic and psychosocial interventions. One scientific article cites three potential forms of therapy that may help those with AUD and co-occurring schizophrenia, including motivational enhancement therapy, contingency management, and cognitive behavioral therapy (CBT). 

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Online therapy 

However, in-person therapy may not be available or convenient for individuals with co-occurring AUD and schizophrenia. In some cases, an individual may not be comfortable driving or taking public transportation while experiencing certain symptoms. Others may not have the motivation or time to find a therapist, or there may not be enough available therapists in their area. In addition, in-person therapy is typically limited to face-to-face sessions. For those who want to try other formats, such as video conferences, online chat, or phone calls, online therapy can be an effective option to explore. 

Research has shown that online therapy and in-person therapy can have similar levels of efficacy. In one study involving individuals with AUD, internet-based CBT and face-to-face CBT were compared on their ability to reduce alcohol consumption. Researchers found that internet-delivered treatment was non-inferior to face-to-face treatment. However, those with co-occurring schizophrenia who are currently experiencing acute psychosis may need to seek in-person support.