Types of Schizophrenia and Addiction
Addiction and Dual Diagnosis Treatment at its Best.
Table of Contents
Types of Schizophrenia
Paranoid schizophrenia is the most common type of schizophrenia.1 When someone has paranoid schizophrenia, they often have delusions and can be very suspicious of other people. This suspicion can lead to high levels of fear and anxiety alongside an inability to decipher reality. Hallucinations, such as hearing voices, may also occur with this disorder.
Disorganized schizophrenia is “characterized by disorganized behavior and speech and includes disturbance in emotional expression.”2 People with this type of schizophrenia can struggle with concentrating or maintaining thoughts.
Those with disorganized schizophrenia may speak incoherently or respond to questions with unrelated answers. They may say illogical statements during conversation or switch topics quickly.2 This type of schizophrenia can also lead to difficulty with beginning or finishing tasks, affecting one’s daily habits and struggles with impulse control. However, people with disorganized schizophrenia are less likely to struggle with hallucinations and delusions.
Residual schizophrenia is a sub-type of schizophrenia where the person no longer shows symptoms. Normally, any hallucinations, delusions, disorganization, or other symptoms tend to be less frequent in comparison to the disorder’s peak.3 Residual schizophrenia can be a very diverse type, and it affects people differently. Symptoms can vary throughout one’s lifetime.
Catatonic schizophrenia affects the way one moves. People can go from being completely still and quiet to hyperactive without any reason.4 Some very common symptoms for catatonic schizophrenia include:
- Not moving or talking
- Sluggish responses
- Staring off into space
- Repeated movements
- Repeating someone’s movements or speech mechanically
Undifferentiated schizophrenia is when a person meets the criteria for a diagnosis of schizophrenia, but they don’t exhibit enough symptoms to be categorized as one specific type. They tend to have symptoms that cover all the other different types of schizophrenia.5
Causes of Schizophrenia
Parents are a big factor in whether their children will one day develop schizophrenia. Only 1% of the general population will develop schizophrenia over their lifetime.6 If a parent struggles with schizophrenia, a child has a 10% chance of developing it in their lifetime.
Brain Structure and Chemicals
Scientists believe that neurotransmitters can also be a cause of schizophrenia. Low levels or imbalances in some chemicals can lead to the development of schizophrenia. Dopamine can cause overstimulation in the brain of someone with schizophrenia.7 Glutamate might also play a role in schizophrenia’s development.
Childhood trauma is believed to play a role in the development of schizophrenia. Childhood trauma could lead to a person experiencing hallucinations related to the abuse they experienced.7
Environmental factors such as drugs may also play a role in this disorder. Drug use does not cause schizophrenia, but it can trigger symptoms in at-risk people. Complications during pregnancy can also determine if a child is likely to develop schizophrenia.
Stressful situations can precede the onset of schizophrenia. This factor is especially true for people who are already at-risk. People with schizophrenia tend to show signs of anxiety and irritability. Schizophrenia can also bring about stressful events, so the relationship between the two is difficult to decipher.
Symptoms of Schizophrenia
Delusional thinking: Delusions are false beliefs one holds even when proven to be false. People who struggle with delusional thinking can have problems concentrating and feel like their thoughts are blocked.8
Disorganized speech: People who struggle with disorganized schizophrenia tend to have trouble collecting their thoughts. They can struggle with day-to-day communication. They might answer questions with unrelated answers, shift topics frequently, or minimize communication entirely.
Catatonic behavior: People with catatonic schizophrenia struggle with movement, and they may become hyperactive for no reason. Some symptoms include staring off into space, sluggish responses, no movement or talking, or repeating someone else’s movements and speech.
Negative symptoms: Negative symptoms may include flat or full emotions. People with schizophrenia tend to struggle with starting or following activities. They may show little to no interest in life or struggle with maintaining relationships. These symptoms tend to be confused with clinical depression.8
DSM-5There are five criteria for schizophrenia.
- The person must have at least 2 of the following symptoms for a significant period with at least one symptom being:
The person must have at least 2 of the following symptoms for a significant period with at least one symptom being:
- Disorganized speech
- Disorganized or catatonic behavior
- Negative Symptoms
The person has experienced a disturbance of functioning in a few major areas in life, and the disturbances are worse than before the onset
There have been continuous signs of disturbance that persisted for at least six months. Some parts of these disturbances can include active and residual symptoms.
Depressive or bipolar disorder with psychotic features, as well as schizoaffective disorder, have been ruled out for the individual.
The disturbances cannot be attributed to the physiologic effects of substances or other medical conditions.
What is Addiction?
According to American Psychiatric Association, substance use disorder (SUD) is a “condition in which there is uncontrolled use of a substance despite harmful consequence.”9 Substance use disorder can cover multiple outlets including drugs, alcohol, sex, work, food, technology, and more. People who are struggling with addiction can be chemically dependent on the substance, which can lead to struggles with distorted thinking and behaviors, changes in the brain’s structure and function, changes in personality, and other behaviors.9
Causes of Addiction
There is never one specific cause of substance use disorder, and it can be vastly different for each person. However, there are some factors scientists have identified that play a role in developing an addiction.
The impact of genetics on substance use disorder varies depending on the substance, but genes do play a huge role. Some gene issues that have been linked to addiction are the A1 allele of the dopamine receptor gene DRD2, a lack of the Htr1b gene, low levels of neuropeptide Y, and a defective Per2 gene.10 Substance use disorder can be called “a family disease” by people in recovery.
Traumatic experiences as a child can cause physical and emotional difficulties later in life. Every adverse childhood experience increases the risk of future problems with substance use. These experiences can also lead to post-traumatic stress disorder (PTSD). Approximately 60% to 80% of those who suffer from PTSD also have issues with substance use.10 The amount of trauma that someone faces in life can greatly impact their likelihood of struggling with SUD.
Some environmental factors that can increase the likelihood of substance use disorder include:
- Peer pressure
- Poor parental supervision
- Parental drug use
- Parental criminal activity
- Presence of drugs at home or school
- Living in a poor community10
However, these factors can be neutralized with protective measures that minimize the risk of addiction.
According to Dr. Elizabeth Hartney, “Addiction often appears to be an attempt to deal with stress in a way that doesn’t quite work out for the individual.”11 The substance of choice might give temporary relief, but substances must continue to enter the body or mind to keep up relief. SUD can bring further stress to a person’s life, causing the need for substances to increase.
Types of Schizophrenia and Its Interaction with Addiction
Schizophrenia and addiction tend to coexist with one another. Mental health can be a significant factor when it comes to someone being more vulnerable to addiction. Approximately 50% of people suffering from schizophrenia have a history of substance abuse.12 Each substance can have different effects on someone struggling with schizophrenia.
Cocaine and Schizophrenia
Higher amounts of dopamine in the brain correlate with more severe schizophrenia symptoms. People who struggle with schizophrenia might use cocaine to relieve symptoms. Cocaine impacts the amount of dopamine and serotonin in the brain. According to an older study, cocaine-abusing patients showed fewer negative signs of schizophrenia at admission.13 People who struggle with schizophrenia and are at-risk for substance abuse may struggle with cocaine due to its overlapping causes and effects.
Marijuana and Schizophrenia
Several studies find that marijuana use as self-medication is common amongst those with schizophrenia. However, marijuana and schizophrenia both produce psychosis. Studies show that marijuana can worsen psychosis in one with schizophrenia.14 However, CBD in marijuana can fight against psychosis. People with schizophrenia that were treated with CBD saw their symptoms improve.14 Overall, some aspects of marijuana can help relieve symptoms of schizophrenia, but other aspects can worsen them.
Alcohol and Schizophrenia
Studies have shown that mood-altering substances such as alcohol can trigger psychosis. Alcohol use disorder can cause hallucinations over long periods. When mixed with schizophrenia, the disorders affect the reward centers of the brain, impacting the frequency and intensity of symptoms that someone with schizophrenia may face.15
Nicotine and Schizophrenia
Almost 90% of people with schizophrenia smoke tobacco products.16 One study at the University of Colorado-Boulder found that nicotine products could potentially reverse the cognitive impairment in the brain that causes schizophrenia. This factor is one reason why people with schizophrenia tend to self-medicate with tobacco products.
Schizophrenia and Suicide
Schizophrenia is linked to a higher chance of suicide or suicide attempts. It can be difficult to prevent these attempts because people with schizophrenia might act on these thoughts impulsively. The risk goes up if someone with schizophrenia develops depression, if they have a history of substance abuse disorder, and if they have a history of suicide attempts.17 Family members and loved ones should pay attention to signs of hopelessness and suicidal thoughts or behaviors.
Schizophrenia and Self-Harm
A person with schizophrenia is more likely to hurt themselves compared to other people. Signs of self-harm such as fresh wounds, multiple scars, and continued insistence on wearing long sleeves and pants can show that potential intervention is needed.18 People with schizophrenia may also self-harm in non-suicidal ways. If someone is struggling with hallucinations or paranoia, they may hurt themselves in the direction of their experiences.
Treating the Different Types of Schizophrenia and Addiction
As always, recovery is a lifelong process that tends to be very difficult. Having a solid community is extremely important for recovery. There are ways to help people live with schizophrenia while also recovering from substance use disorder.
Detox is one of the first steps to recovering. Detox involves removing harmful substances from one’s body.19 Detox should be done under medical supervision as there could be serious side effects.
Cognitive-behavioral therapy (CBT) is a common type of therapy. The goal of CBT is to help the patient become aware of negative thinking so they can view difficult situations more clearly and respond to them more healthily. CBT helps people with schizophrenia develop a plan during hallucinations and delusional episodes. CBT is also an extremely effective way to manage stress and triggers.20
The goal behind motivational interviewing is to help a person change destructive behaviors in their life. Motivational interviewing believes that all people are aware of the negative impact addiction or certain actions have on their life. The role of the therapist is to help reduce fear, anxiety, or apathy so the patient becomes motivated to overcome their addiction.
Those struggling with schizophrenia should receive medication and treatment as quickly as possible.21 Medication alongside therapy can have a huge impact on reducing symptoms. Since the cause of schizophrenia is not known, doctors tend to provide medications that lower and prevent symptoms. These medications are called antipsychotics. There are several antipsychotics, so it is important to speak to a healthcare professional.
Schizophrenia is a very tough disease to manage in isolation. Many times, people who struggle with schizophrenia also struggle with substance abuse. Therefore, starting recovery and being aware of the symptoms are very important. Combining medication with therapy has shown positive outcomes when lowering symptoms of schizophrenia.