Green, A. I. & Khokhar, J. Y. (2018). Addiction and schizophrenia: A translational perspective. Schizophrenia Research, 194, 1–3. https://doi.org/10.1016/j.schres.2017.10.008

Addiction and Schizophrenia

This study aimed to find the prevalence of substance abuse in individuals with psychotic disorders. Results of this study found that the lifetime prevalence of one or more categories of substance abuse and dependence was 39.8% for all psychoses and 42.1% for schizophrenia. The study also found that males were more likely to have a comorbid substance use disorder than females, and younger age groups reported higher use of illegal drugs. 

A Study on the Prevalence of Comorbid Substance Use Disorder and Psychotic Disorders

Integrated treatment is commonly regarded as the most effective form of treatment for individuals with a comorbid Psychotic Disorder and Substance Use Disorder. Integrated treatment involves a combination of treatments from the mental health and addiction fields, including medications and psychosocial treatments, with the aim of treating both disorders in a single treatment program.

Integrated Treatment for Psychotic Disorder and Substance Use Disorder

Since substance use alone can cause psychosis, mania, depression, and cognitive impairment, it is important for all individuals displaying psychiatric symptoms to be screened for substance use. 

In this article, researchers suggested that clinicians should follow these steps:
1. Ask screening questions to determine the quantity, intensity, and frequency of substance use.
2. Request a urine test.
3. Procure self-report questionnaires or structured interviews to uncover potential needs to examine further
4. Examine for negative consequences of substance use.


Screening for Substance Use Disorder in Individuals with Schizophrenia

To develop effective treatment plans it is important to assess one’s willingness to change their behavior. Many individuals with schizophrenia display relatively low motivation to address their substance use disorder. Some tools clinicians can use to determine motivation include:

-- Prochaska and DiClemente’s Five-stage Model of Readiness to Change: Individuals fall into one of five stages (precontemplation, contemplation, preparation, action, and maintenance)

-- Importance, Confidence, and Readiness to Quit Ruler: Includes a 0 to 10 scale assessment of three factors (importance of quitting, confidence in quitting, and readiness to quit)

-- Decisional Balance: Involves discussing the pros and cons of substance use.

-- Dual Recovery Status Exam: Involves ongoing assessment of psychiatric and addiction symptoms



Assessing Motivation for Change in Individuals with Comorbid Schizophrenia and Substance Use Disorder

Since this population is often less amenable to treatment, it is important to keep the patient involved in their treatment planning. The initial treatment plan should concentrate on small, yet meaningful goals that are achievable and reflect the patient’s willingness to change.

The complete treatment plan should include a comprehensive medical assessment, choice of therapy options and medication, ongoing assessment and revision of goals, monitoring of treatment adherence, and strategies for managing ongoing psychiatric issues, interactions between substance use and the psychotic disorder, and related medical issues. Whenever possible, treatment should also include family and friends since strong support systems are important for psychiatric stability and long-term sobriety.

Treatment Planning for Individuals with Comorbid Substance Use Disorders and Psychotic Disorders

There are five fundamental principles that should guide psychosocial intervention for individuals with comorbid psychotic disorder and substance use disorder:

1. Create a supportive therapeutic alliance and work to increase motivation to change.


2. Integrate psychosocial treatments for addictions with mental health psychosocial treatments.


3. Aid the patient in obtaining abstinence and recovery skills.


4. Encourage positive support from others (attendance of 12-step meetings).


5. Employ short-term case management approaches during difficult periods to promote treatment adherence and increase retention. 


Psychosocial Interventions for Comorbid Psychotic Disorder and Substance Use Disorder

Medication is one of the most critical components of treatment for psychotic disorders. However, for individuals with a dual diagnosis of psychotic disorder and substance use disorder, clinicians must consider new treatment options and strategies that are beneficial for the prognosis of both disorders.

Pharmacotherapy for Comorbid Psychotic Disorder and Substance Use Disorder

Based on the provided case study, analyze the interplay between the patient's pre-existing condition and their new behavior. Identify and explain the two most likely negative functional outcomes the patient will face if this pattern continues, drawing direct connections between the substance use and the potential consequences.

Analyzing Comorbidity Outcomes

Based on the information provided in the case study, analyze the most likely reason for this individual's poor treatment outcomes and instability. Explain the relationship between their substance use and the management of their psychotic disorder.

Clinical Case Analysis: Co-occurring Disorders

Individuals with psychotic disorders, such as schizophrenia, schizoaffective disorder, schizotypal disorder, and delusional disorder, have high rates of comorbid substance use disorders, with individuals with schizophrenia having a 5 times higher rate of substance use disorders than the general population. The abuse of substances in people with psychotic disorders is associated with worse symptomatic and functional outcomes including increased rates of hospitalization and relapses, more treatment non-adherence, increased violence, unstable housing/homelessness, brain volume loss, and higher rates of suicide.

Arizona State University

Google

- Falls under the umbrella of substance use disorder. The word "addiction" is not formally recognized in the DSM-5.
- Strong, uncontrollable compulsion to administer a drug of abuse to yourself due to dependence.
- Acts on reward circuitry in the brain (dopamine) and changes the chemical composition of your brain over time.
- According to the DSM 5, only gambling addiction has been listed as a diagnosable disorder, the rest of the behavioral addictions are yet to find themselves a place on the DSM manual.

Addiction

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Individuals with Substance Abuse Disorder may also experience depression. When both conditions are present together, they are more difficult to treat. As a result, researchers have started reviewing different techniques to find a solution to this problem.

Co-occurrence of Depression and Substance-Abuse.

Substance Use disorder and substance dependence refer to the maladaptive pattern of use, leading to clinical distress.

      - Substance dependence is a more severe condition where the individual has trouble controlling the use and is dependent on substances.
       - Substance abuse refers to the residual effects of dependence.

Substance Use disorder and Personality disorder

In this study, researchers explored the implementation of the online platform VetChange as a way to decrease Iraq and Afghanistan veterans' alcohol use and PTSD symptoms . 

Impact of Web-Based Interventions on Veterans' Alcohol Use & PTSD Symptoms 

There are certain genes that can increase your vulnerability to developing addiction in life, combined with the right environmental circumstances. Genes cannot cause addiction completely by themselves, but there have been specific genes associated with substance use disorder. For example the genes GABRA2 and CHRM2 have been linked to alcohol use disorder, and HIST1H2BD has been linked with cocaine dependence. 

Genetic aspect of Addiction

- Drinking Motives Questionnaire
- Leeds Dependence Questionnaire
- Maudsley Addiction Profile (MAP)
- Readiness to Change Questionnaire (RTQ)
- Severity of Dependence Scale
- Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES)

Current Scales to measure addiction disorder symptoms

Negative Reinforcement: Pain avoidance

Positive Reinforcement: Pleasure seeking

Incentive Salience: Craving

Stimulus Response Learning: Habits

Inhibitory Control Dysfunction: Impulsivity 

Theories of Addiction

Substance Use Disorder and Psychotic Disorders

- Sociocultural
- Dosing regimens are not representative 
- Effects of long-term administration of drug use are not conclusive                                     
- Positron Emission Tomography (PET)  is not enough evidence
- Experimental designs are limited to establishing cause and effect 
- Physiological evidence overlaps and is not necessarily clinically significant
- Imaging techniques and clinical assessment are not representative
 

Limitations of drug abuse as a brain disease 

The term "addiction" is not formally recognize in the DSM-5, and is instead labelled under the umbrella term "substance-use disorders." There is a stereotype surrounding addiction that those afflicted with the issue should simply learn to control it, or that they are to blame for engaging in the behavior in the first place. However, these stigmas clearly only worsen a person's condition, leading to the initial question: is the DSM-5's refusal to use the term "addiction" outright leading to additional stigma? Or does it not affect the matter at all? 

Does the DSM-5 not recognizing addiction formally affect the shame and stigma associated with people who struggle with addiction?

Although the traditional ideas of addiction focus more on substance and alcohol use, a growing consensus of information seems to point in the direction of social media addiction also being a form of addiction. Social media addiction refers to the obsessive need to log onto and use different social media platforms and websites. Social media addiction includes withdrawal symptoms, physiological indicators, and psychological impacts as well -- much like traditional addiction. 

Social Media Addiction

Those struggling with addiction often experience high levels of guilt and shame, leading to the initial usage of substances as a way to self medicate. Shame and addiction often end up in a vicious cycle, with people suffering from addiction being shamed for that addiction, and seeking out substances to manage the guilt and humiliation that comes with the shame they are being exposed to. Shame can also often be triggering enough to cause those in rehab and those recovering to relapse, which is why it is crucial that those suffering from addiction be treated with compassion. 

How Shame Impacts Addiction

The most commonly used substances by college students in the United States is reported to be alcohol, marijuana, psychedelic drugs, painkillers, and stimulants. Most of these substances become widely available to students upon entering college, and along with the independence creates an increase in use.

Learn Before

Related

Learn After