Schizophrenia and Substance Abuse

Last Updated: November 2, 2023

Editorial Policy | Research Policy

Co-occurring schizophrenia and substance use disorder can be challenging to manage. It is most effective to treat both conditions simultaneously in a supportive environment.

People with schizophrenia face a wide range of challenging symptoms. As a result of these struggles, it is not uncommon for people to seek symptom relief through substance use. Schizophrenia is an uncommon disorder, with international rates spanning from 0.33 to 0.75% of the population. However, there is a strong correlation between schizophrenia and substance use disorders. Studies have shown that up to 50% of people with schizophrenia have a co-occurring substance use disorder

The Connection Between Schizophrenia and Substance Use Disorder

While the exact cause of schizophrenia is unknown, it is thought to derive from a mix of elements, including genetics, environment, psychological and physical factors. People who are predisposed to schizophrenia may experience their first episode due to a triggering event, such as a severe life stressor or substance misuse. It is important to note that these factors do not cause schizophrenia; they serve as triggers for people who have a genetic predisposition and certain conditions in the brain.

People with schizophrenia may try to escape from symptoms by using drugs or alcohol. These substances can provide temporary emotional relief, but the underlying condition remains, and symptoms worsen as a result of ongoing substance use. Drug and alcohol use in conjunction with schizophrenia symptoms can create a complex co-occurring disorder. 

Treating Schizophrenia and Substance Abuse Comorbidity

With co-occurring disorders, it is vital to treat both needs simultaneously. The risk of only treating substance use or focusing solely on schizophrenia can mean the symptoms of the untreated condition will increase. The stress of quitting drugs or alcohol may exacerbate schizophrenia symptoms if left untreated and vice versa. People who receive co-occurring treatment fare better than those who participate in isolated treatment modes. 

Co-occurring treatment facilities such as The Recovery Village Cherry Hill at Cooper are equipped to help people with schizophrenia and substance use disorder using evidence-based treatment programs. Their treatment teams focus on the whole person, addressing multiple conditions to ensure the best possible results and help patients feel capable of confidently managing life. 

Psychotherapy and Pharmacotherapy to Treat Co-Occurring Conditions

Psychotherapy is an important component of treatment that helps people learn more about their condition while talking about the impact on their thoughts, feelings and daily life. Participating in therapy helps people talk about challenges, learn coping strategies, and identify internal and external triggers. Exploring patterns of substance use and the factors that impact usage can help people create strategies for relapse prevention. Having a safe, confidential place to discuss these issues openly is valuable, particularly when done alongside medication management.

Pharmacotherapy, or the use of medications in treatment, can have a significant, positive impact on a person’s biological processes. When the difficult symptoms of detox and schizophrenia are reduced with medications, people are better able to use therapy to learn additional coping strategies. Using medication and psychotherapy is an effective combination that helps a variety of needs, including co-occurring schizophrenia and substance use disorder. 

What Is Schizophrenia?

Schizophrenia is a chronic brain condition that impacts one’s ability to communicate, think clearly, and stay in touch with the present moment or elements of reality. While schizophrenia is a rare condition, its exact cause is somewhat of a mystery. It is believed to be rooted in genetics, life events and environmental factors. People who have schizophrenia face many additional risk factors:

  • Reduced life-span (by 28.5 years on average)
  • Increased rate of heart and liver disease, and diabetes
  • Greater risk of suicide (4.9% of people with schizophrenia die from suicide)

Risk factors for schizophrenia include:

  • Having a family member with the condition
  • Being genetically predisposed to schizophrenia and experiencing a triggering event (often a severe life stressor or substance use)
  • Environmental factors such as lack of oxygen at birth or other labor complications

Types of Schizophrenia

While the diagnostic criteria remain similar among the fourth and fifth versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the way the disorder is classified has changed a bit. Prior versions of the DSM separated schizophrenia by type, including:

  • Paranoid: Frequent delusions or auditory hallucinations 
  • Catatonic: Verbal or psychomotor changes or immobility
  • Undifferentiated: Characteristic symptoms without meeting criteria for paranoia or disorganization  
  • Schizoaffective disorder: Symptoms of schizophrenia are present but do not meet the full criteria for diagnosis. 

Since the DSM-5 was published, the challenges of one’s unique case are now considered specifiers of severity rather than an individual disorder. For example, rather than Catatonic Schizophrenia, one might be diagnosed with Schizophrenia with catatonia. Changing the way the disorder is labeled is helpful in understanding the symptoms that can manifest. 

Schizophrenia Symptoms

There are a variety of symptoms that can accompany schizophrenia, and they are divided into two types, negative and positive. It is important to understand that positive and negative do not refer to whether a symptom is generally good or bad. 

Negative symptoms represent typical behaviors in someone struggling with schizophrenia, including lack of movement, restricted affect or speech and other deficits as a direct result of the illness. Positive symptoms include those that are atypical or excessive from the usual, such as delusions or hallucinations. Other common symptoms of schizophrenia include:

  • Alogia: Lack of speech or inability to communicate effectively with words
  • Circumstantial thought/speech: Providing excessive, irrelevant detail
  • Derailment: Disconnection of ideas that occurs progressively during conversation
  • Echolalia: Repetition of sounds and focusing on the way a word sounds rather than its meaning
  • Blocking: Sudden interruption in one’s own dialogue, pause in speech and change of subject upon resuming

Effects of Alcohol & Drug Use on Schizophrenia

Many factors influence the way schizophrenia and substance use disorders co-exist, including the severity of each disorder and its intensity, and the type of substances used. There are several substances that are commonly misused by people with schizophrenia: 

  • Alcohol: People with co-occurring alcohol use disorder and schizophrenia are at greater risk of legal trouble, social problems and medical issues. 
  • Nicotine: More than 70% of people who have schizophrenia also use nicotine. This co-occurring condition increases the risk of cancer, heart disease and lung problems.
  • Cocaine: Co-occurring cocaine and schizophrenia contribute to an increased risk of suicide and hospitalization. 
  • Cannabis: Heavy cannabis use is attributed to eliciting a stress response that can promote schizophrenia symptoms for people who are predisposed to the condition.

Schizophrenia and substance use disorder are frequently connected, and unfortunately, outcomes for psychosis and substance use are poor. When people with these co-occurring conditions have access to comprehensive treatment options, however, the outcomes are far more successful. 

Local Treatment for Substance Abuse and Schizophrenia

Co-occurring schizophrenia and substance abuse can be complex to treat. Fortunately, co-occurring treatment exists in New Jersey with accredited treatment centers like The Recovery Village Cherry Hill at Cooper. When multiple needs are treated simultaneously, treatment is far more successful. If you’re struggling with schizophrenia and a substance use disorder, reach out and see how our skilled, compassionate team can support your recovery today. 


National Institute of Mental Health (NIMH). “Schizophrenia.” Accessed December 5, 2021.

Winklbaur, Bernadette et al.“Substance abuse in patients with schizophrenia.” Dialogues in Clinical Neuroscience, 2006. Accessed December 5, 2021.

National Health Service (NHS). “Causes-Schizophrenia.” Updated November 11, 2019. Accessed December 5, 2021.

Flynn, Patrick M, and Barry S Brown. “Co-occurring disorders in substance abus[…]ssues and prospects.” Journal of Substance Abuse Treatment, 2008. Accessed December 5, 2021.

Substance Abuse and Mental Health Services Administration (SAMHSA). “Impact of the DSM-IV to DSM-5 Changes on[…]zophrenia Comparison.” June 2016. Accessed December 5, 2021.

Correll, Christoph U, Nina R Schooler. “Negative Symptoms in Schizophrenia: A Re[…]sment, and Treatment.” Neuropsychiatric Disease and Treatment, February 21, 2020. Accessed December 5, 2021.

Drake, R.E., M.D., Ph.D, Mueser, K.T., Ph.D. “Co-Occurring Alcohol Use Disorder and Schizophrenia.” Alcohol Research and Health, November 2002. Accessed December 5, 2021.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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