Learn / Understanding the Link Between Addiction and Schizophrenia

Understanding the Link Between Addiction and Schizophrenia

Grace Ogren
 January 9th, 2023|   Clinically Reviewed by 
Rajnandini Rathod

Drug addiction and schizophrenia can feel pretty similar. And if you have both, it might be hard to tell where one condition ends and the other begins. Learning about that dynamic is a key part of recovery. That knowledge can empower you to find the right type of treatment for schizophrenia and substance abuse.

Does Drug Addiction Cause Schizophrenia?

In short: no, taking drugs won’t give you schizophrenia. But addiction and schizophrenia have similar causes1—and similar symptoms. The same factors that make you vulnerable to one can also make you vulnerable to the other.

If you have schizophrenia, drug use can trigger your symptoms.2 And depending on what drug you’re taking, being high can even feel like psychosis.3 That’s because both drug use and schizophrenia tamper with your brain’s reward system.4 Here’s why.

The Similar Brain Chemistry of Schizophrenia and Addiction

Taking any drug has an impact on your brain’s reward system.4 And it doesn’t matter what the drug’s actual effects are. The very act of getting high increases your levels of dopamine, a neurotransmitter. So when you take drugs, you feel a sense of reward.

Over time, you’ll need more and more of a drug to achieve that feeling. Reward might be replaced with relief. And as your tolerance goes up, you’ll likely develop a more severe addiction.

Even if you never take drugs, schizophrenia still disrupts your reward system.1 In some people, it decreases baseline levels of dopamine. Or, it can make you hypersensitive to dopamine, so doing drugs feels like an even bigger reward. And if you’re taking drugs that reduce the symptoms of schizophrenia,5 addiction is even more likely.

Self-Medicating to Manage Schizophrenia

While addiction is unhealthy, it often begins as a coping mechanism. You might feel like drug use helps you control the symptoms of schizophrenia.6 And, in some cases, that might even be true. For example, nicotine reduces psychotic symptoms.7 But that doesn’t mean cigarettes are good for you.

In the long term, addiction continues to destabilize your reward system. Because of this, ongoing drug use can exacerbate your schizophrenia symptoms. This complicates the process of recovery.

Treatment for Both Schizophrenia and Addiction

Quitting drugs isn’t a cure for schizophrenia.8 But for some people, it’s an important first step toward healing. And because of the overlap between addiction and schizophrenia,9 many of the same treatments might help with all your symptoms.

If you’re recovering from both these conditions, you might benefit from treatment for co-occurring disorders. Within that framework, there are several specific therapies that can help.

Motivational Interviewing

Motivational interviewing (MI) helps patients with schizophrenia10 commit to ongoing treatment. It’s an especially effective treatment for people with both addiction and psychosis.11

MI isn’t technically a type of therapy. Instead, it’s a conversation style that many different clinicians apply to treatment. Therapists, doctors, nurses, and others can all use this approach. During MI, they’ll use active listening, pointed questions, and other techniques. This can help you find your personal spark of motivation to heal.

Contingency Management

For patients with both schizophrenia and addiction, contingency Management (CM) can make recovery more likely.12 This approach rewards your participation in treatment. For example, you might get a gift card, voucher, or even cash for going to a therapy session. You and your care team will write and honor a treatment contract, defining prizes for each activity. In most cases, the value of your rewards will go up over time. For many people, this agreement motivates positive changes.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) was originally developed to treat borderline personality disorder. Today, it has many additional uses. For example, DBT can help patients with schizophrenia,13 addiction, and other mental health conditions.

Sessions of DBT can feel more like classes than therapy. You’ll meet with a group, go through a workbook, and even do homework. You might also have 1:1 sessions with your therapist. Patients learn practical skills in 4 modules: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. These coping strategies can empower you to live a healthier life.

Cognitive Behavioral Therapy

Like DBT, cognitive behavioral therapy (CBT) focuses on practical coping skills. CBT helps patients with addiction and schizophrenia14 manage their symptoms without drug use.

Instead of trying to change your feelings, CBT shows you new ways to respond. Future episodes of psychosis might always trigger drug cravings. But you’ll learn how to accept that feeling and move on, instead of falling back into addiction.

Specialized Care in Rehab

Schizophrenia is often a lifelong condition. Instead of “fixing” all of your symptoms, treatment empowers you to manage them. These strategies are far more sustainable than addiction. And in an effective rehab program, you can heal from both at the same time.

Browse rehabs that treat schizophrenia to see locations, photos, reviews, and more.

Reviewed by Rajnandini Rathod

  1. Khokhar, J. Y., Dwiel, L., Henricks, A., Doucette, W. T., & Green, A. I. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia Research, 194, 78–85. https://doi.org/10.1016/j.schres.2017.04.016 [] []
  2. Causes—Schizophrenia. (2021, February 12). Nhs.Uk. https://www.nhs.uk/mental-health/conditions/schizophrenia/causes/ []
  3. Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-induced psychoses: An updated literature review. Frontiers in Psychiatry, 12, 694863. https://doi.org/10.3389/fpsyt.2021.694863 []
  4. Powledge, T., Addiction and the brain: The dopamine pathway is helping researchers find their way through the addiction maze, BioScience, Volume 49, Issue 7, July 1999, Pages 513–519, https://doi.org/10.2307/1313471 [] []
  5. Potvin, S., et al. “[Schizophrenia and addiction: An evaluation of the self-medication hypothesis.” L’Encephale, vol. 29, no. 3 Pt 1, May 2003, pp. 193–203. []
  6. Batel, P. (2000). Addiction and schizophrenia. European Psychiatry, 15(2), 115–122. https://doi.org/10.1016/S0924-9338(00)00203-0 []
  7. Quigley, H., & MacCabe, J. H. (2019). The relationship between nicotine and psychosis. Therapeutic Advances in Psychopharmacology, 9, 2045125319859969. https://doi.org/10.1177/2045125319859969 []
  8. “Schizophrenia.” World Health Organization. https://www.who.int/news-room/fact-sheets/detail/schizophrenia. Accessed 9 Jan. 2023. []
  9. Gouzoulis-Mayfrank, Euphrosyne, and Marc Walter. “Schizophrenia and Addiction.” Co-Occurring Addictive and Psychiatric Disorders: A Practice-Based Handbook from a European Perspective, edited by Geert Dom and Franz Moggi, Springer, 2015, pp. 75–86. Springer Link, https://doi.org/10.1007/978-3-642-45375-5_6. []
  10. Fiszdon, Joanna M., et al. “Motivational Interviewing to Increase Cognitive Rehabilitation Adherence in Schizophrenia.” Schizophrenia Bulletin, vol. 42, no. 2, Mar. 2016, pp. 327–34. PubMed Central, https://doi.org/10.1093/schbul/sbv143. []
  11. Bagøien, G., Bjørngaard, J. H., Østensen, C., Reitan, S. K., Romundstad, P., & Morken, G. (2013). The effects of motivational interviewing on patients with comorbid substance use admitted to a psychiatric emergency unit—A randomised controlled trial with two year follow-up. BMC Psychiatry, 13(1), 93. https://doi.org/10.1186/1471-244X-13-93 []
  12. Adams, Claire E., et al. “Contingency Management for Patients with Cooccurring Disorders: Evaluation of a Case Study and Recommendations for Practitioners.” Case Reports in Psychiatry, vol. 2012, Jan. 2012, p. e731638. www.hindawi.com, https://doi.org/10.1155/2012/731638 []
  13. Kemp, Cheyenne (2018) “Dialectical Behavior Therapy as a Possible Treatment Modality for Schizophrenia,” Intuition: The BYU Undergraduate Journal of Psychology: Vol. 13 : Iss. 1 , Article 7. []
  14. Morrison, A. K. (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont), 6(12), 32–39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/ []

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