Alcohol and Schizophrenia: What's the Connection?

Schizophrenia is a serious mental condition that affects 24 million people worldwide, making it one of the top 25 causes of disability around the world.

Living with schizophrenia can be incredibly distressing. It can cause a number of challenges, such as difficulty going to school or work, keeping a schedule, socializing, completing daily tasks, and generally taking care of oneself.

Furthermore, people with schizophrenia are significantly more vulnerable to substance abuse. One study showed that 47% of people with schizophrenia have problems with drugs or alcohol, compared with 16% of people without the condition.

Other research indicates that people with schizophrenia are three times more likely than the general population to engage in heavy alcohol use. This is particularly problematic, since combining alcohol and schizophrenia can cause even greater mental and physical health issues. Can alcohol cause psychosis? Can alcohol cause schizophrenia? And does alcohol make schizophrenia worse? Let’s take a closer look at alcohol, schizophrenia, and the relationship between the two.

Understanding Schizophrenia

Schizophrenia is a chronic brain disorder that affects how someone thinks, feels, and behaves. It is usually characterized by experiencing delusions (false beliefs), hallucinations (seeing or hearing things that don’t exist), unusual physical behaviors, and disorganized thinking and speech.

It’s also common for people with schizophrenia to have paranoid thoughts or hear voices. For instance, they might believe that someone is controlling their mind or going to cause them harm. These psychotic episodes can be incredibly frightening, confusing, and isolating.

While experts don’t have a full understanding of what causes schizophrenia, it is believed that genetic makeup and brain chemistry play a large role. The condition affects slightly more men than women, who often get diagnosed later in life than men. Men tend to experience symptoms in their late teens and early 20s and women in their mid-20s to early 30s. In general, clinical signs of schizophrenia are often less severe for women.

Schizophrenia and Alcohol: The Connection

Does alcohol make schizophrenia worse? Generally speaking, alcohol negatively affects the way our brain works and processes information, which is why it’s not smart to drink with any mental health disorder, including schizophrenia. But combining alcohol with schizophrenia is particularly dangerous, as it can worsen symptoms and lead to severe complications.

If we already have schizophrenia and are misusing alcohol, our symptoms will likely worsen.

Furthermore, people who have schizophrenia and alcohol-use disorder are at a greater risk for other medical and social complications, such as depression, suicide, homelessness, noncompliance (not following treatment), aggression, violence, incarceration, and hospitalization.

Studies also indicate that alcohol use with schizophrenia not only leads to an increase in physical aggression, but it also leads to an even greater increase in physical aggression victimization, especially for women.

Can Alcohol Cause Psychosis?

When it's misused over a long period of time, alcohol has the potential to cause psychosis, similar to what many people with schizophrenia experience. Known as alcohol-induced psychosis, it causes symptoms that mimic or overlap with symptoms of schizophrenia, such as hallucinations, delusions, and disorganized thought and behavior. (We should note this isn’t exactly the same as alcohol-induced schizophrenia, which we’ll discuss next).

Can Alcohol Cause Schizophrenia?

While alcohol-use disorder doesn’t cause schizophrenia, research indicates that having one of these disorders increases our likelihood of being diagnosed with the other. For instance, one study noted that people experiencing schizophrenia reported substance use between 30 and 70 percent of the time, and nearly 1 in 5 reported alcohol misuse.

Similarly, researchers have suggested that alcohol use in adolescence is a predictor of having both a mental health disorder and substance use disorder later in life.

While some people assume that people with schizophrenia self-medicate with alcohol to treat their symptoms — and therefore develop a dependency — research hasn’t necessarily supported this idea, as many people misuse alcohol before getting schizophrenia. For instance, one study found that 36% of participants reported having alcohol use disorder before their first episode of psychosis.

One theory suggests that schizophrenia impairs the reward and motivation circuits in our brain, which is similar to the impairment caused by alcohol-use disorder. Furthermore, alcohol-use disorder may also have a genetic component: studies have found a significant overlap between the genes related to alcohol-use disorder and those related to schizophrenia.

Schizophrenia and Alcohol Misuse Warning Signs and Treatment

People with schizophrenia who drink heavily might end up homeless, isolated, hospitalized, incarcerated, or facing legal problems. They tend to have worse health outcomes and repeated relapses because they may not stick with a treatment plan.

For those with schizophrenia and alcohol-use disorder, treatment typically includes long-term antipsychotic medication, psychosocial interventions, and medication for alcohol dependence. It’s vital that both of these conditions are treated simultaneously since they often happen together.

Recent research indicates that the newer class of antipsychotic drugs — called “atypical” or “second-generation” antipsychotics — work better for people with schizophrenia and alcohol dependence than the older “first generation” drugs. In fact, some studies indicate that first-generation antipsychotics may even increase alcohol use and craving in people with schizophrenia and alcohol-use disorder.

One study supports the use of clozapine, an atypical antipsychotic, for people with both schizophrenia and alcohol-use disorder. Results showed that a larger proportion of people treated with clozapine achieved remission from alcohol-use dependence compared with those taking another antipsychotic drug. Participants also had lower relapse rates a year later.

Another study found that participants with alcohol-used disorder and schizophrenia who were treated with naltrexone (a medication used to treat alcohol-use disorder) reported far fewer drinking days, fewer heavy drinking days, and fewer cravings compared with the placebo group.

If we or a loved one has schizophrenia and alcohol-use disorder, it’s vital to contact a medical professional, who can help develop an individualized treatment plan. Keep in mind that the sooner we get treatment and stick with it, the better our chances of managing our condition and getting better.

Finally, if you find yourself struggling to control your alcohol intake, Reframe can help. We’ve helped millions of people cut back on their alcohol consumption and become physically, mentally, and emotionally healthier in the process.