Alcohol and Drug Comorbidity with Schizophrenia: Impact and Treatment

This report examines the comorbidity of alcohol and drug use with schizophrenia, exploring factors contributing to this dual diagnosis, the impact on individuals, and appropriate treatment and management practices. It highlights socio-economic factors such as poverty, unemployment, and social isolation as drivers for substance abuse among those with schizophrenia. The paper also addresses the debate around self-medication versus symptom exacerbation through substance use, and the challenges in treatment adherence and prognosis for comorbid patients. The report concludes by advocating for integrated treatment approaches, emphasizing the importance of addressing both the psychiatric disorder and substance abuse in a coordinated manner to improve patient outcomes and quality of life, while also noting the need for further research to establish specific treatment guidelines.

Running Head: ALCOHOL AND OTHER DRUGS AND SCHIZOPHRENIA CORMOBIDITY
Alcohol and other Drugs and Schizophrenia Comorbidities
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Introduction
According to the scientific literature, 20% to 50% of patients with schizophrenia also
have alcohol dependence or abuse (Gammeter 2005). In these comorbid conditions, the use of
antipsychotics of first and second generation is effective despite a poorer response to treatment
than patients without alcohol problem. Note also that the risk of suicide is increased in
schizophrenic patients with alcohol dependence, with some studies suggesting a risk multiplied
by three. In this context, this research paper attempts to determine some of the possible factors
responsible for alcohol and other drug and schizophrenia comorbidity, the impact of comorbidity
and the treatment and management practices that should be carried to address the issue.
Body
Factors responsible for the development of alcohol and other drug and schizophrenia
comorbidity
The factors that compel people with mental health to engage in drugs are socio-economic
factors. It is recognized that schizophrenia is associated with cognitive and social deficits;
however, deficits associated with bipolar illness are not so clearly established. Some studies
show that, when compared to schizophrenics, individuals with bipolar illness present similar
difficulties at the social level, as well as at the cognitive level (Goldberg 1999). For example,
people with severe mental disorders generally have low levels of education, lack of professional
skills and are therefore, very often unemployed. Indeed, many studies find that the difficulties
these individuals face directly contribute to low employability. For example, Goldberg (1999)
found that among a sample of individuals with severe mental illness, those who were
unemployed had greater cognitive difficulties,

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As mentioned, not only do these individuals have cognitive difficulties, but also social
difficulties that, on the one hand, are detrimental to their job performance or job search, and
which also interfere with their family and social relationships. These difficulties associated with
the disease, and the resulting low employability rate, push some individuals toward poverty and
isolation, preventing them from returning to their pre-morbid level of functioning.
Indeed, Fox (1990) wanted to observe the level of integration of 81 schizophrenics seven years
after being discharged from a psychiatric hospital. They found that 47% were socially isolated
and 94% were unemployed. Not surprisingly, Goldberg (1999) report that schizophrenia occurs
in 8.7% of homeless people, while it affects only 1% of the general population. For individuals
with both severe and persistent mental illness and concomitant substance-related disorder,
research shows that these individuals also suffer from poverty, a low level of education, low
social support, lack of employment, lack of social, cognitive and vocational skills.
People with severe and chronic mental illnesses have many cognitive, social and
professional deficits, and only a minority are successful in getting hired and maintaining a job
(Mueser, Drake, Ackerson, Alterman, et al. 1997). Isolated and unemployed, most of them live
in poverty. It is easy to imagine the extent of the financial difficulties faced by those who, in
addition, depend on expensive substances. Since they do not have the money to support the usual
expenses of such an addiction, they are surely obliged, like the regular population coping with an
addiction disorder, to use whatever means are available to them. to get that money.
These individuals would thus go through the same stages as the majority of the regular
population, first seeking to reduce overall expenses, increase working hours, if they have a job,
to borrow money, and then to sell their property, to finally commit lucrative crimes that are
likely to become more and more violent, as the level of consumption of the individual increases

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(stealing money from loved ones to hand theft) army, for example). Indeed, the more the
consumption of the individual increases, the more his desire to obtain money quickly increases.
He may become desperate and, no matter what the consequences may be, his crimes become
more impulsive and less organized.
For example, Green (2004) report that one in five inmates report that the purpose of the
offense at the time of incarceration was to obtain drugs. As individuals with both severe and
substance-related disorders commit more violent crimes than non-violent crimes and have
cognitive, behavioral and social, it is possible to believe that the latter, driven by a strong
motivation to obtain money, act even more impulsively than the regular population, quickly
using unorganized means, therefore more risky. Especially since some authors observe that
cocaine-dependent schizophrenics experience more intense states of need than the regular
population (Wallace 2004), which, presumably, would probably motivate them to act more.
In addition, they consume drugs to address the symptoms of their illnesses. Contrary to
what the self-medication hypothesis, Khantzian (1997) proposes that individuals with psychiatric
disorders consume in order to reduce some symptoms of their illness, Drake and Mueser (2000)
report, following A review of scientific literature shows that substance-related disorders in this
population have the same characteristics as those in the regular population, even with respect to
the reasons individuals in both groups consume. Warner et al . (1994) explain that if these
individuals actually consumed self-medication, we would observe a general tendency to consume
a specific substance in order to calm a specific symptom of a certain mental illness.
Other studies have found that, in schizophrenics, antipsychotics, with the exception of
some atypical antipsychotics such as clozapine, quetiapine or risperidone, do not have a
mitigating effect on substance-related disorders and can, on the contrary, to precipitate or

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exacerbate them. Indeed, some antipsychotics cause these patients unpleasant side effects, such
as neuroleptic dysphoria, they try to mitigate with the help of psychoactive substances.
Brunette, Noordsy & Green (2005) reviewed different types of studies that attempted to
explore the relationship between psychoactive substance abuse and psychotic symptoms in
schizophrenic or schizoaffective patients. Laboratory studies show that hallucinogens and
amphetamines sometimes increase positive psychotic symptoms. Correlational and longitudinal
studies show that the use of cocaine and cannabis is often associated with an exacerbation of
positive symptoms and that alcohol and cocaine often cause an increase in depressive
symptoms. The results are not consistent since half of the studies say that there is a relationship
between substance abuse and the presence of more acute symptoms, while the other half do not
observe any relationship (Tiihonen, Isohanni, Rasanen, Koiranen & Moring 1997).
More recently, Fox (1990) combined the results of a series of independent studies that
compared the rates of positive and negative symptoms reported by schizophrenics with a
substance and by those that do not have such comorbidity. This analysis allowed him to observe
a greater importance of positive symptoms and a lower presence of negative symptoms in the
first group than in the second group. Note, however, that this study does not establish a causal
relationship between these findings and the presence of a substance-related disorder, which may
be the cause or consequence of a greater significance of symptoms. positive.
Based on the results obtained from these studies, it is possible to suggest some
hypotheses for adapting the psychopharmacological component to the population of individuals
with both a severe and persistent mental disorder and a substance-related disorder.
First, the fact that the type of drug consumed is associated with disinhibition and
psychosocial instability in this population, as in the general population, that the effects sought by

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consumers are also the same, and since substance-related disorders are have the same
characteristics in both groups, it is possible to ask why the presence of these disorders is not
associated with violence in individuals with severe mental disorders, if it has been in the regular
population (Green 2004).
Impact of alcohol and other drug and schizophrenia comorbidity
Among the problems encountered in the treatment of people suffering from comorbid
disorders, there is greater difficulty for the patient to request and then adhere to a treatment
(Green 2004). Many studies have found that non-adherence to psychotropic medication is a very
common phenomenon in the population with both a severe and persistent mental disorder and a
substance-related disorder. There is also a more frequent occurrence of physical co-morbidities,
cognitive disorders, relational disorders, lack of motivation, and finally there are heavier social
issues (weak resources, incarceration, violence) (Magura 2008). As a result of this can be
highlighted a greater frequency of crisis situations and a more reserved prognosis in comorbid
patients. In particular, in the case of schizophrenia, of the major depression and bipolar disorder,
that the presence of an alcohol problem is related to a significant increase in the rate of death by
suicide (Compton 2007).
These results suggest that in the addictological and psychiatric fields the presence of
comorbidity is a factor of poor prognosis and greater complexity of treatment and that their
research should be done more systematically in order to offer optimal management of both
problems.
Treatment and management of Alcohol and other alcohol and schizophrenia comorbidity
An observational study hypothesizes that participation in 12-step, specialized dual
diagnosis group programs could promote community support in a doubly stigmatized population

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and, as a result, improve adherence to treatment addictological and quality of life of patients
(Brunette, Noordsy & Green 2005). However, the availability of this type of treatment is very
low.
Apart from this, there is little solid scientific evidence to recommend a specific treatment
device for people with alcohol dependence and psychiatric comorbidity. A broad consensus of
experts, however, recommends an integrated treatment of both problems, ideally by the same
person who can be punctually assisted by specialized consultants. In the case of parallel
treatment by several specialists, the recommendation is to integrate the information and
coordinate the treatment plan by a close communication between the speakers, by designating a
case manager, central interlocutor of the patient and the care network (Horsfall 2009).
Moreover, depending on psychiatric pathologies, it is also important to adapt the treatment plan
to the patient's cognitive, relational and self-management abilities, and in some cases to call on
those around him to support certain disabilities.
Medically, no solid scientific data is available. Apart from the controversy regarding the
administration of benzodiazepines for anxiety disorders and alcohol dependence, the
recommendations are to treat both conditions in parallel with usual treatments considering the
pharmacological interactions between drugs and alcohol.
Conclusion
The nature of the links between psychiatric disorder and alcohol problem remains
unclear, but it is important to keep in mind the confounding factors related to the psychotropic
effects of alcohol both in the phase of acute consumption (impulsivity, excitation, depression)
than withdrawal (anxiety, psychotic symptoms in case of delirium tremens), as well as cognitive
disorders related to chronic exposure of the brain to alcohol (Dassori 1990).

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The association between alcohol use disorder and psychiatric disorder is strong and
common, and patients with one problem are at risk of not being investigated for the other
condition. These comorbid conditions are associated with poorer adherence to treatment, heavy
somatic comorbidities, poorer prognosis, poorer quality of life, and increased suicidal risk. It is
therefore crucial for a patient with an alcohol problem to systematically seek the presence of a
psychiatric comorbidity (and conversely in a patient with a mental disorder to seek an
addictological comorbidity) in order to propose a treatment that considers of all problems in the
most integrated and coordinated way possible. Network conductor are required to obtain a
realistic and effective treatment plan.

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