Longterm Substance Abuse and its Association
with Schizophrenia: A Review Article
Sohaib Siddiqui1, Sukaina Rizvi2, Talha Naser Jilani3 and Ali Mahmood Khan4*
1 Ross University School of Medicine, USA
2Kings County Hospital Center, USA
3 Ziauddin University, Pakistan
4 Kings County Hospital Center, USA
Submission: June 11, 2018; Published: June 27, 2018
*Corresponding author: Ali Mahmood Khan, Kings County Hospital Center, New York, USA.
How to cite this article: Sohaib S, Sukaina R, Talha N J, Ali Mahmood K.Longterm Substance Abuse and its Association with Schizophrenia: A Review
Article. Open Acc J of Toxicol. 2018;3(3): 55555614. DOI: 10.19080/OAJT.2018.03.555614.
This is a review article that discusses substance abuse, its relationship and/or the effects it has on patients suffering from schizophrenia. Substance abusers sometimes develop symptoms that closely mimic the symptoms of those suffered in schizophrenia and in some cases drug abuse or substance abuse may set the stage for the onset of the disorder known as schizophrenia. It is long believed that substance abuse has adverse effects on schizophrenia. Substance abuse, commonly known as drug abuse, is the consumption of drugs or other substances in such amounts or methods which is harmful to the person himself or the people around him/her. In certain cases such acts lead to criminal or anti-social behaviors due to the influence of the drug or substance that is abused. Schizophrenia is a chronic mental disorder that has adverse effects on how a person feels, thinks and behaves which leads to the person feeling disconnected from reality and cannot differentiate between what is reality and what are only just the person’s thoughts.
The following research is being conducted to find out what effects, if any, does substance abuse have on patients suffering from schizophrenia. They can either be beneficial or not but, it seems to be highly unlikely that the effects would be beneficial. According to researches performed previously, substance abuse has severe effects on schizophrenic patients and it is also reported that nearly all of the patients who present with schizophrenia also have a previous history of drug abuse of some sort.
According to studies conducted, people with schizophrenia have abused substances at some point in time with alcohol and cigarette smoking or nicotine being the most widely abused substances. Such illnesses in which substance abuse and mental illnesses both are involved are often called concurrent disorders or co-occurring disorders. Patients usually abuse drugs that are readily available such as cannabis, alcohol and nicotine. Other over the counter prescriptions such as tranquilizers and sleep medications may also be misused.
First of all, what is substance abuse? Will the abuse of any substance be harmful to the human body? To answer these
questions we will have to look into what exactly substance abuse is and what it means. Substance abuse can be described as any substance taken in such amounts that it alters the mood, mental state and social well being of a person. Most commonly abused substances are alcohol and cigarette whereas other drugs such as cocaine, marijuana, heroin and many other drugs are commonly abused.
Schizophrenia belongs to a group of mental disorders known as psychotic disorders. It is a disorder in which the ability of the patient to think feel and act is greatly altered. Due to this, patients have a false sense of reality and have a hard time distinguishing between their imagination and reality and also a loss of normal emotional expression and motivation. Therefore it is very difficult for such patients to be themselves or to express themselves openly in front of other people and social gatherings. The causes of schizophrenia still seem to be unknown. It is at times said to be a genetic disorder. At times it is believed that it is because of disrupted brain structures or chemistry. It has also been associated with viral infections and immune disorders. Unfortunately, the exact cause of schizophrenia cannot be pointed out. Patients suffer from various side effects such as delusions, hallucinations, speech and behavior motor deficits and disordered thinking . In order to be diagnosed as a
schizophrenic patient, one must develop at least 2 of the classical
symptoms within a time period of 30 days. The patient should
not just be suffering from hallucinations or delusions. Along with
those two the patient must also have decreased motivational
levels and responsiveness. Due to these symptoms it is common
that the patient has incoherent or side tracked speech. Patient
will at times posses an extremely chaotic behavior and catatonic
states that produce either excited movements that are pointless
or the patient may have a rigid body with unresponsive lack
of movement. However in some cases a patient may also be
diagnosed with schizophrenia upon the possession of only
one symptom too for example extreme delusional states or
hallucinations. Along with ongoing symptoms, patients must
also complain of generalized effects of the disorder for around
6 months. It is highly unlikely that someone below the age of
sixteen may suffer from schizophrenia and the chances to get
the disorder are also diminished after the age of 45. This leaves
us with a window of almost around 14 years between the ages
of 16 to 30 that it is highly likely that a patient will present
with schizophrenic symptoms. In a research conducted, it was
emphasized that adolescence is a very important period in
life when regions of the brain associated with impulsitivity,
addiction and motivation are developed .
During this adolescence phase in life, environmental factors
are described as risk factors for the onset of psychiatric disorders
. Males and females are almost affected in the same ratio so
there is little chance that the disorder is prevalent or affects
males more than females or vice versa. Substance abuse in
schizophrenic patients is recognized as a clinical phenomenon.
It is not necessary that substance or drug abuse causes
schizophrenia but it is highly likely and in many cases patients
who suffered from schizophrenia also were substance abusers
hence relating the two but still not clearly if substance abuse is
the reason why schizophrenia occurs. It could or could not be
the case. Schizophrenic people commonly abuse substances
including nicotine, alcohol, cocaine, and cannabis, and they
experience more cognitive impairment, more intense psychosis,
and, thus, an increased need of emergency services. They are
also more prone to legal troubles and incarceration. Drugs may
aggravate psychotic symptoms however some abused drugs
may lead to symptom reduction in subgroups of schizophrenic
patients . It is surprisingly found that nicotine could reverse
haloperidol-induced deficits in memory and complex reaction
time in patients with schizophrenia but the effective treatment
dose of antipsychotic medications is increased in smokers due
to the smoking-induced increase in neuroleptic metabolism .
Smoking cessation is recommended for mostly everyone
involved in the habit but according to reports nicotine improves
cognitive performance in schizophrenic patients . Quitting
smoking may not be easy at all though. It is very difficult for
normal smokers to withdraw smoking due to the effects due
to the lack of nicotine and disrupts the mood. Couple this with
a patient suffering from schizophrenia and it gets even worse.
Due to cessation of smoking in schizophrenic patients, nicotine
withdrawal may cause their psychotic symptoms to get worse
for a short period of time. The effects of drug abuse or substance
abuse in patients suffering from schizophrenia and it effects
depends upon various factors and it cannot be narrowed down
to just a few people suffering from schizophrenia. There have
been consistent findings that males of younger ages are more
likely to be addicted or are at a higher level of risk for substance
abuse. It depends upon various factors such as how the patients
are diagnosed with schizophrenia, the populations studied and
mainly what ways drug and alcohol disorders are defined as .
In recent years, various publications however state that there
is a high prevalence of substance abuse in schizophrenia[8-10].
Studies indicate that out of all patients suffering from
schizophrenia, half of them have problems with drugs and
alcohol whereas 70% of all patients were addicted or dependant
to nicotine . Like stated above, it may or may not be necessary
for people who are substance abusers to be diagnosed with
schizophrenia later on in life, if for instance a person suffering
from schizophrenia who also happens to be a substance abuser,
the effects of substance abuse may cause him to not be able to
follow his or her treatment plan for schizophrenia effectively
and on time hence worsening the condition, delaying treatment
or making it worse for the good. Some substances such as
nicotine from cigarette smoking have lesser side effects or
after effects than patients who abuse other substances such as
marijuana. Marijuana and other amphetamines or cocaine make
the symptoms worse. The main active ingredient in marijuana is
known as tetrahydrocannabinol or THC.
This active ingredient exerts a strong effect in two regions
of the brain, the prefrontal cortex and the hippocampus. These
two centers play an essential role in the human ability to make
judgments and in the formation or access of memories. The
same structures show degeneration in patients suffering from
schizophrenia. When people who are mentally healthy smoke or
ingest marijuana, the experience they have is more or less close
to being the same as to that of a schizophrenic patient. Keeping
this phenomenon in mind it is not hard to understand that with
time, gradual degeneration of these structures in the brain due to
the drugs such as marijuana abused increases the risk of people
to suffer from schizophrenia especially in people who already
suffer from other mild symptoms of schizophrenia.
For the treatment of such patients who have schizophrenia
and also have a positive history of drug abuse and are still
using it, it is important to identify both problems first. After
identification, a treatment plan should be made accordingly to
the patient’s drug of abuse for example a smoker to be advised
to quit smoking for better result in schizophrenia treatment.
But that is easier said than done. The patient in such a case
can be advised to go for other methods to quit such as chewing on nicotine gums or to change brands and smoke cigarettes
that have a lower percentage of nicotine than the cigarettes
that the patient used to smoke before. Along with that the
patient can be advised to use nicotine patches. Treatment for
schizophrenia usually involves the use of antipsychotics and
or psychotherapy if needed. Treatment for drug abuse also
includes the use of medications and forms of therapy known as
cognitive behavior therapy or CBT and other therapies such as
contingency management or multidimensional family therapy. It
is also important to note that the medications, treatment plan or
therapy in drug treatment varies according to the nature or type
of the drug being used.
It can be stated that substance abuse worsens the conditions
of patients already suffering from schizophrenia for multiple
reason stated above. If not worsen, people are a high risk and
are vulnerable to suffer and develop schizophrenia especially in
some abusers like in marijuana abusers. To treat schizophrenic
patients, it is also important that the drug abuse also be
recognized because it hinders the treatment of schizophrenia
and also in some cases where mental state of patients is also
compromised, treatment may be forgotten to implement or
delay the treatment as it is hard to follow when intoxicated.