Patients with schizophrenia who abuse drugs or alcohol are called dual-diagnosis patients. A dual-diagnosis patient has two diagnoses;  in this case,  schizophrenia and substance abuse.

Research suggests that schizophrenia patients are at an increased risk of having a substance-abuse problem. In fact, someone with schizophrenia is more than four times more likely to have a substance-abuse problem than someone without schizophrenia.

Approximately 47 percent of patients with schizophrenia have a diagnosis of substance abuse. That’s nearly one-half of all patients with schizophrenia. Substance use is a particularly serious problem for patients with schizophrenia because drug use by schizophrenia patients increases the chance that a patient will become violent or get into trouble with the law. Schizophrenic substance abusers are less likely to benefit from traditional treatment. They are more likely to refuse to take their medication, are less likely to respond to psychological treatments, and have poorer overall functioning and an increased chance of relapse.

As a result,  dual-diagnosis patients end up costing society a great deal. They require more financial resources in terms of legal intervention and repeated psychological treatment.  The unique economic burden of dual-diagnosis patients has driven researchers to figure out how best to treat these complicated problems.

Why would schizophrenia patients be more likely to abuse drugs or alcohol? To begin, many schizophrenia patients use drugs because they believe that they might help relieve their symptoms. Some patients use drugs or alcohol instead of taking prescription medication, a process called self-medicating.

Unfortunately, some drugs, such as cocaine or methamphetamine, can actually make schizophrenia symptoms worse.

Patients who are taking their medication and still use drugs may find that the drugs interfere with the good effects of their medication.

One’s living or social environment, specifically one in which there is increased access to drugs, can make it more likely that schizophrenic patients become drug abusers. Downward drift suggests that patients with schizophrenia may live in poorer neighborhoods as a function of their mental illness. Drugs may be more accessible in impoverished neighborhoods.

Finally,  the symptoms of schizophrenia,  specifically poor interpersonal skills, might lead some patients to associate with people who use drugs.  In an attempt to find a community, someone with schizophrenia might find it easier to be accepted by people whose lives revolve around drug use. In this situation, someone with schizophrenia might start using drugs in order to fit in. Living with schizophrenia as part of one’s identity is a challenge and one that is difficult for society to accept. Perhaps some patients with schizophrenia find it easier to live as a drug addict rather than as someone with mental illness. All in all, schizophrenia patients who abuse drugs and alcohol can be problematic for treatment professionals.

Where does a schizophrenia patient with a substance abuse problem go for help?  In the past 20 years,  clinicians and researchers have realized the need for a treatment program for dual-diagnosis patients. Research has shown that dual-diagnosis patients need help managing both disorders in order to improve their chances of recovery. As a result, many hospitals or treatment settings now have dual-diagnosis treatment programs especially designed for these challenging patients.

In a dual-diagnosis program, clinicians will focus on features of schizophrenia and substance abuse. Most important, they will address the implications of the combination of these disorders.  Dual-diagnosis treatment builds upon standard medication and therapy. Some patients may need housing assistance to help them move away from an environment that allows them easy access to drugs. Other patients might need to learn behavioral skills to help them avoid or say no to drugs or alcohol. Finally, many patients need to learn money management skills from their treatment team. When access to money is limited, access to drugs is limited as well. Making sure a patient is accountable for where each dollar is spent can help the patient avoid using drugs.

Caring for someone with schizophrenia can cause family members great stress and they are encouraged to find support for themselves.  Family members worry about their relatives becoming homeless or committing suicide,  both common occurrences in patients with schizophrenia. Most schizophrenia patients are not particularly violent or likely to get into trouble with the law. Dual-diagnosis patients pose a unique challenge to treatment and society at large.

Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.

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