Psychotic Disorders & Drug Abuse
People who struggle with schizophrenia or other psychotic disorders may abuse drugs and alcohol as a means of coping with their disorder.
Dealing with drug abuse and mental health issues is challenging because addiction is a mental illness in and of itself. Diagnosing a mental health issue in a person with addiction can also be difficult because drug abuse causes profound changes that could be mistaken for a mental illness.
People with undiagnosed mental health illnesses often turn to drugs as a means of self-medication. While substances may provide a temporary escape from symptoms, they ultimately lead to more problems overall.
Treatment can help people improve their quality of life, address underlying issues, and understand the relationship between psychotic disorders and the mental health impacts of drug misuse.
Psychotic disorders are mental illnesses that feature symptoms like hallucinations and delusions. These disorders cause individuals to lose touch with reality.
They are marked by two major symptoms:
- Hallucinations: feeling, seeing, or hearing things that are not there
- Delusions: believing falsities to be true, such as believing the media is sending subliminal messages to them
The types of psychotic disorders.
- Schizophrenia: (See: Schizophrenia Subtypes)
- Schizoaffective disorder: This mental illness consists of schizophrenia and episodes of mania and depression.Experts are still doing their best to understand the disorder and have separated it into two categories:
- Depressive: schizophrenia with depressive episodes
- Bipolar: schizophrenia marked by periods of mania and depression
- Postpartum psychosis: This occurs only in 1 to 0.2 percent women who have given birth. It is less common that postpartum depression. A family history of psychosis appears to influence its onset.Women experiencing postpartum psychosis require immediate treatment and are at increased risk of suicide.
Schizophrenia is a chronic psychotic disorder that makes it difficult for people to be independent. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) used to list subtypes of schizophrenia, but these were removed as a diagnosis after changes to the latest edition of the manual.
Today, schizophrenia subtypes are used for clarification purposes. These are the five subtypes:
- Catatonic schizophrenia: People affected by catatonic schizophrenia experience disruptions in movements that leave them unable to move (catatonic stupor) or excessive movement (catatonic excitement).
- Disorganized or hebephrenic schizophrenia: This refers to people whose behavior, thoughts, and speech are disorganized. This behavior must be present for up to six months.
- Paranoid schizophrenia: This is one of the most familiar terms for schizophrenia because the name was used for years before the DSM-5 did away with schizophrenia subtypes. It is associated with hallucinations, delusions, incoherent speech and behavior, and suicidal ideation.
- Residual schizophrenia: This was once a more general diagnosis after symptoms like delusions, hallucinations, and incoherence diminished.
- Undifferentiated schizophrenia: This was once a label used whenever a physician noticed symptoms of more than one subtype of schizophrenia. Now that subtypes are no longer used for diagnosing the illness, clinicians only use this label to note that a patient is experiencing various symptoms of schizophrenia.
Symptoms of schizophrenia are categorized into three groups.
- Cognitive: These include problems that affect how one thinks or acts.
- Difficulty concentrating
- Problems using information to make decisions (diminished executive function)
- Lowered ability to use information properly after learning it
- Positive: These symptoms describe behaviors not seen in people without a psychotic disorder or schizophrenia, such as “losing touch” with reality.
- Erratic movements and thoughts
- Negative: These include disturbances to normal patterns of feelings and behavior.
- Changes in attitude, such as feeling decreased happiness
- Difficulty starting and finishing new things
- Less speaking
- Lack of expression via facial cues and voice (flat affect)
Getting a Diagnosis
Before a doctor considers psychotic disorder schizophrenia as a final diagnosis, they will rule out other mental health disorders, substance abuse, and other medical conditions. The process of diagnosing schizophrenia will likely include:
- A medical exam. This will let your doctor rule out physical conditions or complications.
- Testing. Blood, alcohol and drug tests, and brain scans, such as a CT scan or MRI, are often used.
- Mental health evaluation. This will be done by a psychiatrist to rule out other mental health disorders or issues. Your family and medical history will be discussed as well.
- Screening for psychotic disorders. A mental health professional will screen for a psychotic disorder using the DSM-5 and their observations.
Substance Misuse & Psychotic Disorders
As mentioned by the National Institute on Drug Abuse (NIDA), substance misuse and mental health illnesses, including psychotic disorders, often coexist. Data shows that people with mental health illnesses often have a co-occurring substance use disorder because:
- Mental health illnesses can cause a person to turn to drugs. Some people self-medicate to deal with the symptoms or consequences of an undiagnosed disorder.
- Substance abuse can worsen or trigger mental illnesses.
- Substance use disorders and mental health issues are affected by similar risk factors, such as environmental factors or genetic predisposition.
A psychotic disorder and substance abuse can both be treated at the same time. This is the recommended approach for co-occurring disorders to best improve overall quality of life.
The National Institute on Drug Abuse (NIDA) outlines strategies for effective treatment of drug abuse:
- Treatment must take a person’s individual needs and issues into account.
- For best results, treatment must address a person’s legal, social, physical, and mental health problems. It can’t only address addiction.
- Experts must recognize that many people with substance use disorders often have mental health disorders as well. These mental health issues must be treated.
Treatment for drug abuse and treatment for mental health disorders, such as psychotic disorders, often overlap. Methods used to treat both disorders include:
- Medications. Individuals dealing with addiction to alcohol, opioids, tobacco, and benzodiazepines can benefit from medication-assisted treatment (MAT). This type of program uses medication to manage withdrawal symptoms and cravings, and counseling is required by law to be part of the programs. The goal is to manage symptoms of withdrawal, decrease cravings, and prevent relapse.People with opioid use disorder are often prescribed methadone and buprenorphine, so they can overcome their addiction and live healthier lives. Over time, they may be gradually weaned off the maintenance medication.
Antipsychotics like haloperidol, fluphenazine, and chlorpromazine are available to help people deal with the symptoms of schizophrenia. Atypical antipsychotics are also sometimes used, including clozapine, olanzapine, and quetiapine.
Both antipsychotics and atypical antipsychotics are known to have side effects, but they can greatly reduce the symptoms of schizophrenia.
- Counseling. In addition to dealing with mental health issues, counseling teaches patients skills they need to stay away from drugs, overcome obstacles in case of relapse, and discover the reasons why they turned to drugs. Commonly used approaches are cognitive behavioral therapy, family and group therapy, and contingency management.
- Support groups. These are often 12-step groups or alternative support groups run by peers who face the same obstacles. They allow members to foster a sense of community while working toward recovery as well as managing schizophrenia.
Both psychotic disorders and addiction require lifelong treatment, but neither disorder is a death sentence. People with both conditions live fulfilling, robust lives, thanks to good management of their issues.
Dealing with a psychotic disorder and substance use disorder, or trying to help a loved with these conditions, is not easy. The resources below can offer information on treatment programs, counseling, and other forms of help for those struggling with mental health issues and substance abuse.
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: SAMHSA’s national helpline is available 24/7, 365 days a year. Call them at 1-800-662-HELP (4357). If you have a TTY, call 1-800-487-4889.The call is free and confidential. They can provide useful information and connect you to community resources. For more information, click here.
- SAMHSA’s Online Services Locator: You can find search for specific types of treatment by location. There are options available in every state.
- National Suicide Prevention Lifeline: This is a confidential helpline you can call during moments of crisis, particularly if you are feeling suicidal. Reach them at 1-800-273-8255. For more information, visit their website.
Statistics on Schizophrenia
The National Institute on Mental Health (NIMH) explains that it is difficult to track down exact figures on people who have schizophrenia. This is what they know so far:
- Schizophrenia usually starts to show symptoms between the ages of 16 and 30.
- Men generally exhibit symptoms around late adolescence or as young adults.
- Women tend to show symptoms of schizophrenia in their late 20s and early 30s.
- Children and adults who are 45 or older are rarely diagnosed with schizophrenia.
- People may exhibit subtle changes years before schizophrenia becomes fully present.
- An estimated 0.25 to 0.64 percent of Americans may have schizophrenia or another psychotic mental illness.
- An estimated 50 percent of people with schizophrenia also have another behavioral or mental illness.
- Among people with schizophrenia, about 4.9 percent die by suicide. This rate is higher than the general population rate.