Co-Occurring Disorder Series: Understanding Schizophrenia And Substance Use Disorder Part 1

Co-Occurring Disorder Series: Understanding Schizophrenia and Substance Use Disorders Part 1

While reading up on and learning about schizophrenia and substance use disorder may actually be an easy thing to do—after all there is a set list of possible symptoms, set criteria for substance use severity—trying to understand and help an individual with these co-occurring disorders may be something else entirely. Oftentimes this becomes difficult because of the mental illness part and the lifelong struggles that can come with that, without proper support and treatment. While there is always hope and healing possible, living with schizophrenia or living with a loved one with schizophrenia, may be something about which many know nothing, so I would like to start off with some education.

What Is It?

While we all have an image in our heads when the terms, “drug user” or “depressed” come up, it is important to have a good definition of what we are talking about, as those images may be scarily accurate at times, there are others where depression does not quite look the way one would think. There are individuals with serious substance use problems who may hold down a job and be upstanding members of the community. Our thoughts and ideas may hit the mark, but the truth is human behavior is so complex that our ideas very rarely cover 100 percent of the population.

Substance Use Disorder (SUD) is presented in the DSM-5 on a continuum of mild to severe, depending on how many symptoms are present. The more symptoms, the more serious the disorder is and the more risk the person is at in life overall. These are (APA, 2013):

  • Taking the substances in larger amounts and for longer than intended
  • Wanting to cut down or quit but not being able to do it
  • Spending a lot of time obtaining the substances
  • Craving or a strong desire to use substances
  • Repeatedly unable to carry out major obligations at work, school, or home due to substance use
  • Continued use despite persistent or recurring social or interpersonal problems caused or made worse by substance use
  • Stopping or reducing important social, occupational, or recreational activities due to substance use
  • Recurrent use of substances in physically hazardous situations
  • Consistent use of substances despite acknowledgment of persistent or recurrent physical or psychological difficulties from using the substance
  • Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount
  • Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal

So we can see the impact of SUD on a person’s life by the symptomology here and the problems that arise from continued, increasing use. Or to put it more concisely, the more a person cuts off parts of their life for substance use, the worse the problem really is.

Schizophrenia was something I thought growing up meant multiple personalities, both out of ignorance and pop culture references that came out of the origin of the word from Greek meaning “split mind” when schizophrenia was first being described in the early 1900s. This could not be any further from the truth.

Schizophrenia is in the category of thought disorders, where individuals have problems with their cognition (or thinking) and understanding and interpreting reality. Typically this disorder will manifest during adolescence into young adulthood, where increasingly eccentric behaviors will turn into a full-blown psychotic episode. Those afflicted will then begin to lose connection with and the ability to interpret reality. This is a mental illness that responds best to medication and supportive therapy to help control the symptoms or prevent further psychotic episodes; this will be discussed further in the follow up, part 2, to this article on treatment and support of loved ones.

The symptoms seen here fall into one of two categories, termed positive and negative symptoms. Positive and negative here do not mean good or bad, they simply mean either their symptoms are things not usually present in the general population or their symptoms are things that are in the general population, but they are lacking. Positive symptoms, those more commonly associated with schizophrenia, include:

  • Hallucinations, with any of the senses, but auditory hallucinations are by far the most common
  • Delusions, false beliefs that are highly unlikely in reality, such as the CIA monitoring your breakfast conversation
  • Disordered thoughts and speech, inability to put coherent thoughts or sentences together, that come out as literally random words strung together

The negative symptoms or deficits in abilities can include:

  • Little or no emotion displayed or possibly, termed a flat affect
  • Inability to process or comprehend things in reality cognitively, especially abstract concepts or anything that is not a concrete object
  • Little or no ability or desire to form relationships with other people
  • Reduced pleasure or joy in life than average

Reminder: while a person may have schizophrenia, he or she may not have all of these symptoms or there may be a small chance another symptom may appear as a result of the disease that is not on this list.


Statistics should be used to help understand the problem as a whole to begin with and then to help understand the individuals and provide the best care and support possible. It is in that spirit that I write about what this co-occurring disorder looks like statistically. And in the case of schizophrenia, it is one of the highest rates of SUD among all the mental illnesses (Winklbaur et al, 2006), so understanding this is a priority.

Overall, individuals diagnosed with schizophrenia are approximately 1.1 percent of the population in the United States (NIMH, 2016). When looking at the population of individuals with schizophrenia, the majority of people will use: nicotine, alcohol, marijuana, and opiates; and looking at people with schizophrenia, approximately 60 percent of people diagnosed with it will use some psychoactive substance (Winklbaur et al, 2006).

The other statistic I feel is important to mention is about outcomes. With medication and support, recovery is possible and quite likely; however, due to the nature of the disease, connecting with mental health treatment is a challenge at best. People without proper treatment will have a lifespan shorter by almost 20 years than average, have much higher chances of death by suicide or by accidental overdose, are more likely to be homeless, and are less likely to seek out and receive medical attention (NIMH, 2016).

This is atrocious. And that is why I write these articles to help educate, inform, and hopefully provide some support and guidance for people that need it. In the next article I will talk about treatment and support for people with this co-occurring disorder cluster.

Click Here To Read Co-Occurring Disorders: Understanding Schizophrenia And Substance Abuse Part 2


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
National Institute of Mental Health. (2016). Schizophrenia. Retrieved from
Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance Abuse in Patients with Schizophrenia. Dialogues in Clinical Neuroscience, 8(1), 37–43.

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