Schizophrenia and Substance Abuse; Which Came First, the Chicken or the Egg?
Terry V. Hites
Dual Diagnosis / Co-Occurring Disorders
December 6, 2008
Schizophrenia and substance abuse; which came first, the chicken or the egg? This is a greatly debated topic within families of schizophrenics that abuse alcohol. In this paper I hope to explore the prevalence of substance use with those that suffer from schizophrenia, the age of onset and the age of first use, treatment issues, recovery issues, and finally, the issues regarding the high rate of suicidal thoughts, attempts, and completions within this specific population of individuals. “The 2002 National Survey on Drug Use and Health in the United States found that over 23% of adults suffering from serious mental illness abused alcohol or other drugs. In the population without a serious mental illness only 8.2% abused alcohol or other drugs. Among adults who abused alcohol or other drugs, 20.4% had a serious mental illness” (Cherry, 2007, p. 37). “Over 75% of people with a co-occurring disorder who were surveyed during treatment reported a history of childhood physical abuse” (p. 38). Interestingly enough, surveys have shown that individuals are readily willing to address their substance abuse but are not so willing to acknowledge their co-occurring mental illness (p. 49-50). “The lifetime prevalence of substance use disorders (SUD) in schizophrenia is close to 50%. Substance abuse in schizophrenia is associated with numerous negative consequences, including psychotic relapses criminality, homelessness, unemployment, treatment non-compliance, and health problems” (Potvin, 2007, p. 792). In this population, “substance abuse is highly prevalent” (p. 792) not just used by a few individuals; but people will abuse substances to cope with the negative or positive symptoms of their illness. When looking at the symptoms that they experience, Potvin goes on to say, “addicted schizophrenia patients suffer from more severe depressive symptoms, relative to non-abusing patients” (p. 793). Furthermore, the research also shows that males experience the depression more severe than females (p. 797); the depression scale includes anhedonia, psycho motor retardation, etc. (p. 796). Keith goes on to say, “Substance abuse affects approximately half of patients with schizophrenia and can act as a barrier to compliance” (2007, p. 259). “The lifetime prevalence of substance abuse (excluding smoking) in patients with schizophrenia has been estimated to be approximately 35 to 55%” (p. 260). “In addition to experiencing these more severe symptoms, or potentially also as a result, psychosocial problems such as occupational, housing or financial difficulties and crime are endemic in the dual-diagnosis population” Keith asserts (p. 261). When examining the prevalence of the co-occurring disorders, one would be remiss to not identify the etiology of each.
“It could be tempting to conclude that PAS [psychoactive substances] use exacerbates depressive symptoms in a subgroup of schizophrenia patients, because long-term use of alcohol, cannabis and cocaine is associated with depressive symptoms” (Potvin, 2007, p. 797). Although these assertions may be concluded, it is also important to not “draw inferences about causality, and the reverse explanation cannot be ruled out. That is, severe depressive symptoms may lead patients to use PAS, as proposed by the self-medication hypothesis” (p. 797). “Psychoactive substance use in juveniles and adults is highly correlated with a number of psychiatric diagnoses, including schizophrenia. Young adults with schizophrenia have a 3 times higher prevalence of substance use disorders (SUD’s) than the corresponding age group in the US general population." (Hsiao, 2007, p. 88). While the amount of research data on this age group is limited due to studies not addressing them, it is difficult to generalize the data collected (p. 88)....
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