Substance Abuse

How SUDs Affects Schizophrenia

Introduction

            The purpose of this paper is to enumerate the many therapy techniques and methodologies for managing Substance Use Disorders (SUDs) in adults who also suffer from schizophrenia. It is often exceedingly difficult to treat patients afflicted with both maladies, partly due to the uncanny similarity in each condition’s cause and symptom list.  The other major constituent in treatment difficulty can be attributed to the sheer extremity of which these symptoms or ailments may be suffered.  More simply put: schizophrenic patients who are also struggling with some variation of SUDs are often described as some of the most difficult patients to treat (Buckley, 1998).

            Another fact to consider in the treatment and management plan for a schizophrenic individual who also suffers from SUDs is the comorbidity of the two conditions.  It so happens that as hard as it may be to treat either of these conditions alone, they are very likely to be present together, making for a sort of “perfect storm,” in a sense.  In fact, the comorbidity of schizophrenia and substance abuse are scientifically proven to go biologically hand-in-hand (Chambers et al., 2001). One study revealed abnormalities in the hippocampal formation and frontal cortex create an inflated neurobiological reinforcement of drug reward, as well as reduced control over drug-seeking behavior (2001). It is also true that more than half of adults who are afflicted with schizophrenia are also suffering from some type of substance abuse disorder (Buckley, 1998).  To better understand the combination, however, it is still best to break them apart, symptom by symptom.

Understanding Symptoms of Schizophrenia

Hallucination

            All persons afflicted with schizophrenia may find themselves suffering a variety of symptoms including delusions and false beliefs, hallucinations (visual or audible), disorganized thinking and speech, disorganized motor behavior, and trouble concentration (Patel et al., 2014). Individuals with schizophrenia are not all cut from the same cloth. There is a broad spectrum for schizophrenia, with both individuals suffering severe symptoms and individuals suffering lighter symptoms. Unfortunately, if left untreated, schizophrenia symptoms are most likely to worsen and occur more frequently (Ran et al., 2015).

Understanding Symptoms of Substance Use Disorders (SUDs)

            Individuals suffering from any form of any Substance Use Disorder may experience a range of symptoms, depending upon the severity of their affliction and combination of other mental conditions.  Some of the symptoms of SUDs include exaggerated confidence or exhilaration, increased alertness or energy, major behavior changes, aggression or violence, rapid or disorganized speech and thought, dilated pupils, irritability, anxiety, paranoia, delusions, hallucinations, and confusion (Volkow, 2020). SUDs can offer additional diagnostic and treatment difficulties in that many users will abuse multiple substances (sometimes literally at the same time).  The comorbidity rate of various substances is shockingly high. Simply put, individuals who may abuse a drug are more likely to also abuse alcohol (Shantna et al., 2009). For example, it is well known that marijuana and alcohol share a powerful comorbidity and their presence together in an individual suffering from SUDs is extremely likely if the individual partakes in marijuana at all (Button et al., 2007).

Developing an Effective Treatment Plans

            An effective treatment plan for a patient suffering from both schizophrenia and SUDs would include methodologies which safely satisfy ailments of both disorders.  This plan would benefit from arranging treatment priorities depending upon the severity of risk of the aggregated list ailments.  In other words, a solid treatment plan would prioritize treating any tendencies of self-harm, suicidal activity, and suicidal ideation ahead of some other symptoms which incur less severe consequences (such as disorganized speech or thought).  The treatment plan should include methodology suitable for the personality of the individual.  For example, while use of certain pharmaceutical approaches (like Olanzapine) may prove extremely helpful for some patients, others will show menial responses to the medication, or none at all (Littrell et al., 2001).  Another patient may have had some contributing factors in developing either or both of their conditions which are still present in their environment (e.g. a negative influence or undesirable social situation). Treatment plans are less likely to be effective when constituent environmental factors remain the same (Bennett et al., 2001). 

Treatment plans for adults suffering from both schizophrenia and substance use disorders must be carefully refined over time.  This is to account for poor treatment compliance, potential modes of response from the patient, and the overall learning curve required on the service provider’s side (Winklbaur et al., 2006).  Even with the comorbidity of these maladies creating a more difficult treatment process, there is great hope if a persistent therapist or psychologist provides regular treatment modifications consisting of a variety of therapeutic paths (2006). After all, it could be argued that the congruency of the symptoms of the two conditions are so similar that their causes and underlying contributing factors are similar as well.  This could allow the service provider an opportunity to view the extreme comorbidity of these disorders as a treatment benefit in terms of being able to reduce symptom severity of shared symptoms at the same time, with the same treatment technique.

Dialectical Behavior Therapy (DBT)

            Dialectical Behavior Therapy (DBT) is a newer form of Cognitive Behavior Therapy, offering a variety of skills to replace faulty behaviors (Pederson, 2020).  DBT addresses issues that create critical difficulties in life functioning.  There are many skills which can be adopted by implementing DBT, including Life Vision, Wise Mind, Observation, Description, Participation, Nonjudmental Stance, One-mindfulness, Effectiveness, Teflon Mind, and many more (2020).  Implementing DBT skills will help an individual cope in all areas of their life, giving a natural responsibility in having a skillful response. 

DBT offers a number of advantages for individuals suffering from schizophrenia and substance abuse.  DBT is easier to afford, more accessible, requires minimal commitment, is fully engaging, and it is non-stigmatizing. All these advantages come with the additional benefit of learning successful management techniques for a schizophrenic (Sandoval et al., 2017). DBT is also extremely effective treatment for substance abusers (Dimeff and Lineham, 2008).  DBT is especially known to be able to reduce the frequency and duration of adverse symptoms from individuals suffering from SUDs and a mental disorder of many types (2008). Although some challenges for implementing DBT in a schizophrenic suffering from SUDs may exist, it is very easy to try DBT multiple times until it “sticks” (Sandoval et al., 2017).

Conclusion

            Overall, there are many methodologies for treating substance abuse in schizophrenic adults which have been published throughout many well-renown journals and texts.  The meta-analysis of many studies is pointed to show extremely high rates of comorbidity between the two conditions. It is possible, however, with the right combination of adaptive therapy, behavioral treatment plans, and possible pharmaceutical regimens to reduce the severity of many SUDs (and also schizophrenia) symptoms (Bennett et al., 2001). And it is more than reasonable to argue that obtaining these skills and effective treatment methods will lead to better management of an individual’s symptoms, improved decision making, improved relationships and self-worth, and a better life.

References

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Buckley, P., (1998). Substance Abuse in Schizophrenia: A Review. Journal of Clinical Psychiatry. Vol. 59(3). Pp. 26-30. Retrieved from: https://www.psychiatrist.com/wp-content/uploads/2021/02/17913_substance-abuse-schizophrenia-review.pdf

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Patel, K. R., Cherian, J., Gohil, K., and Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management. Vol. 39(9). Pp. 638–645.

Pederson, L. (2020). The Expanded Dialectical Behavior Therapy Skills Training Manual. Second Edition. Pesi Publishing and Media. Pp. 6-285. ISBN: 9781683733072.

Ran, M. S., Weng, X., Chan, C. L., Chen, E. Y., Tang, C. P., Lin, F. R., Mao, W. J., Hu, S. H., Huang, Y. Q., and Xiang, M. Z. (2015). Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China. The British journal of psychiatry : the journal of mental science. Vol. 207(6). Pp. 495–500. DOI: https://doi.org/10.1192/bjp.bp.114.157685

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Volkow, N., (2020). Personalizing the Treatment of Substance Use Disorders. American Journal of Psychiatry. Vol. 177(2). Pp. 113-116. DOI: https://doi.org/10.1176/appi.ajp.2019.19121284

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