The Schizophrenia Spectrum and Substance Use

The schizophrenia spectrum contains a category of mental disorders that are characterized by the following symptoms:

  1. Delusions–delusions are fixed beliefs that hold up against evidence to the contrary. Some delusions are notably bizarre and unbelievable to anyone else.
  2. Hallucinations–hallucinations are distortions in one’s perception of reality. They are typically related to the senses. For example, one may see, hear, smell, taste or feel something that is not present.
  3. Disorganized Speech–disorganized speech reflects disorganized thinking such as not being able to maintain a train of thought.
  4. Disorganized or Catatonic behavior–behaviors can range from difficulty completing tasks to extreme and unusual forms that are socially inappropriate or lead to lack of self-care and safety. Catatonic behavior is an extreme ‘shutting down’ of behavior.
  5. Negative Symptoms–negative symptoms typically reflect the ‘absence’ of something. For example, the emotional range is restricted and without much fluctuation. There may be sparse or lacking motivation or speech.

The diagnosis of a mental condition within the schizophrenia spectrum requires at least 2 of the symptoms above to be present. 1 of the first 3 must be evident (delusions, hallucinations, disorganized speech).

Schizophrenia Disorders and Substance Use

Almost one half of people who have a schizophrenic disorder also have some sort of substance disorder during their lifetimes. This is dramatically greater than the general population which is cited at typically less than 10%. Common substances used by those with a diagnosis involving a break from reality include nicotine, cannabis and alcohol.

Dual Diagnosis Treatment

People with both a condition on the schizophrenia spectrum and a Substance Use Disorder require dual diagnosis treatment. Dual diagnosis treatment addresses both conditions at the same time. This requires specially trained professionals that understand how to diagnose and treat dual or co-occurring disorders. Since there are many complex interactions between dual disorders that lead to relapse, it is especially important that both conditions be stabilized simultaneously. Otherwise, if one is not managed, it can cause relapse in the other.

Dual diagnosis treatment settings range from outpatient clinics to inpatient or residential programs. The severity of symptoms are considered when a particular setting is chosen. It is possible that these co-occurring disorders can cause an inability to care for one’s self and to be safe for awhile. In those cases, a safe and therapeutic environment is necessary until there is improvement. In any clinical setting it is important that such a dual diagnosis issue is monitored by a psychiatrist since it is likely that medication will be needed to treat the schizophrenia spectrum disorder.