Co-Occurring Schizophrenia and Alcoholism: Effective Treatments

Co-occuring conditions

As many as 50% of all individuals suffering with schizophrenia also meet the criteria for substance abuse disorder. According to the 2014 National Survey on Drug Use and health (NSDUH), 43.6 million Americans, aged 18 and over, experience some form of mental illness.

It further reports that in the past two years, 20.2 million adults have a substance use disorder, and of that, 1.4%, 7.9 million people suffer from a dual diagnosis of serious mental health disorder and substance abuse disorder.

A serious mental health disorder is defined as having a diagnosable mental, behavioral, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.

Connection Between Schizophrenia and Substance Use

There are several determinants for schizophrenia and substance use. One is psychosocial factors. Individuals with co-occurring schizophrenia and alcohol use, scored higher on measures of sensation seeking and impulsivity than those without a comorbid substance use disorder.

Man considering treatmentMotivational factors are another determinate for increased substance use in those with schizophrenia. Most commonly reported reasons for abusing alcohol is to relax, increased pleasure, reduce negative effects, psychotic symptoms, and to be more sociable. Stress is another related factor for comorbid issues.

Stress can cause individuals to choose maladaptive strategies, such as alcohol, to reduce stress associated symptoms. Biological factors can also affect why schizophrenic individuals use alcohol and other drugs to self-medicate to reduce the disorders symptoms and/or reduce the side effects of antipsychotic medications.

Abnormal neuropathways that come with schizophrenia may also increase the reinforcing effects of substance use. Schizophrenia involves dysregulation of the brain chemical dopamine and alcohol increases dopamine in some areas of the brain.

Stages of Treatment

People with schizophrenia and alcohol use typically go through 4 stages of treatment:

  1. Engagement which involves trusting the treatment team and building a therapeutic relationship;
  2. Persuasion of developing and maintaining motivation to manage both illness to obtain recovery;
  3. Active Treatment which is the development of skills and supports needed for recovery;
  4. Relapse Prevention which looks at tools, and strategies to minimize relapse.

There are different types of effective therapies that can be used in treatment.

Man on beach in recoveryOne is Behavioral Therapy, which works on targeting specific behaviors and creating healthy coping skills and tools. Another therapy is Pharmacology (medication management) to help with symptom management and enable individuals to have some therapeutic benefit from ongoing work.

There are several therapies that are used in the treatment of schizophrenia and substance use, which are following. In adolescents several types of therapies can be used. One is Multisystmeic Therapy (MST) which targets key factors such as peer pressure, neighborhood culture, attitudes and beliefs, family dynamics. Brief Strategic Family Therapy (BSFT) targets family interactions and dynamics. Cognitive-Behavioral Therapy (CBT) looks at modifying maladaptive beliefs and behaviors.

Adults also have several therapies to address comorbid issues. Therapeutic Communities (TC) is where the individual can re-socialize using broad-based community programs as treatment. This focuses mostly on legal issues, vocational concerns, homelessness, etc.

Assertive Community Treatment (TC) is where programs integrate behavioral treatment of several mental health disorders and substance use with Acceptance Commitment Therapy, team management, case management, outreach and individualized treatment plan. Dialectical Behavioral Therapy (DBT) is designed to reduce self-harm behaviors and drug abuse. Exposure Therapy can work with individuals who struggle with trauma, anxiety, and PTSD, which can intensify substance use and severe mental disorders.

Addressing Mental Health Issues

Ideally, the same treatment team should address both the mental health and substance use issues. They should be treated in the same setting and have a shared set of goals and recommendations. Comprehensive treatments have been shown to be effective for treating both.

Man on beach in addiction recoveryTreatment for this includes staged treatments, outreach, motivational interventions and pharmacology. Staged intervention is when the client’s needs are met, working on therapeutic alliance, obtaining recovery skills and planning for relapse prevention. Assertive Outreach is when clients and families are involved in intensive case management (often in clients homes) to help gain access to community and federal resources.

This type of treatment also helps client maintain consistent treatment. Motivation interventions are those programs which motivate clients to stay and engage in treatment. Active treatment involves using cognitive-behavioral or evidence based therapies. Social support interventions work to improve the social environment of the client to promote recovery.

In conclusion, those clients suffering with schizophrenia and alcoholism struggle to maintain healthy coping strategies to manage symptoms. Many turn to alcohol to reduce the symptoms and medication side effects.

With a seamless, holistic approach to treatment, recovery and symptom management can be effective. Working with a treatment team, case manager, and accessing community resources recovery and management is possible.

Community Discussion – Share your thoughts here!

What treatments do you feel are effective for schizophrenia and alcoholism? What has worked best for you or a loved one?

Image of Libby Lyons and familyAbout the Author: Libby Lyons, MSW, LCSW, CEDS, is a Certified Eating Disorder Specialist (CEDS) who works with individuals and families in the area of eating disorders. Mrs. Lyons works in the metropolitan St. Louis area and has been practicing in the field for 11 years. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. Mrs. Lyons has prior experience working with the United States Air Force, Saint Louis University, Operating Officer of a Private Practice, and currently works with both Saint Louis Behavioral Medicine Institute within their Eating Disorders Program and Fontbonne University


[1]: Drake, Robert E., Mueser, Kim, T., Co-Occurring Alcohol Use Disorder and Schizophrenia. Alcohol Research and Health, 2002.
[2]: Petraktis, Ismene., How to Best Treat Patients with Schizophrenia and Co-Occurring {3]: Alcohol Use Disorder. Journal of Clinical Psychiatry. 2014
[3]: Thoma, Patrizia, Daum, Irene. Comorbid Substance Use Disorder in Schizophrenia: A Selective Overview of Neurobiological and Cognitive Underpinnings. The Journal of Psychiatry and Clinical Neurosciences. 2013
[4]: Retrieved from 2016
[5]: Retrieved from 2016

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 21, 2016
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.