Co-Occurring Disorders: Understanding Schizophrenia And Substance Abuse Part 2
The first part of this series on schizophrenia and substance use disorder (SUD) described the two disorders—both as far as symptomology go, how they may appear and act, as well as the statistical prevalence of this co-occurring pair—and some information on individuals who are diagnosed with them. This is probably one of the more challenging diagnoses to work with, considering sometimes the people who professionals will treat may be totally disconnected from reality or have such cognitive disruptions that speech is impossible. But even in the space of all that, help and hope are available and effective treatment options do exist. I will close this section discussing treatment options as well as support services for everyone involved; client, friends, and family alike.
The first course of treatment for schizophrenia is medication. As I stated initially, schizophrenia is more of an organic disorder, a problem in the brain itself, not one’s personality or upbringing. Medication is thus the best and first course of treatment. With proper medication and monitoring of its use, 50 percent of people diagnosed with schizophrenia will lead symptom free, or significantly reduced symptom, lives (NIMH, 2016). This is not a cure. There is no cure as of yet, so this will likely be a lifelong regimen. Now, if one medication has bad side effects, please remember there are many others, so do not give up on just one.
Other medications can be used with antipsychotics, antidepressants, or anti anxiety medications, for one example, and a combination may provide the most benefit to a person. As always, consult your prescribing physician when it comes to any medication choices or changes. There are medications that will help with coming off drugs, for example; opiate agonists like Suboxone that help with withdrawing from and reducing cravings for opiates. One final thing to consider: it may be helpful when talking to your doctor to have a loved one or other supportive person with you. Oftentimes doctors have a lot of information to give but unfortunately only a small amount of time to give it, so having someone else there can help to ensure that all the important bases are covered.
This is an important area of treatment for anything, but it also has one of, in my opinion, the worst names for any treatment strategy. Psychoeducation basically means just teaching people about any diagnoses they may have, what the recommended and possible treatment strategies are, and healthy/unhealthy choices to the best of current information. This is important for this co-occurring disorder because the main goal for treatment of either disorder is the same: relapse prevention. The idea is to teach people what their individual healthy and unhealthy behaviors are that put them at risk for relapse or reduce risk of relapse, what their warning signs are for trouble or deterioration of their condition, and what steps would be the most helpful when things start to get tough. It really is about arming people, clients and loved ones alike, with the information necessary to have the highest possible chance of a happy and healthy life.
Talk therapy is still used with those who have thought disorders, although it may look different than with someone else who is dealing with depression, for example. Talk therapy will be a more focused and structured event. It will typically be targeting specific behaviors that are unhelpful or unhealthy and trying to connect that to the consequences. Cognitive behavioral techniques will be most often used, focusing on thoughts that get in the way of goals and good health, changing those thoughts, and changing behaviors as well.
It should be well-known by now that everyone needs support now and again. The amount of support needed will vary from person to person, based on all the needs, challenges, strengths, and deficits each has. But support is needed and it can come in many forms. Frequently, if a person is receiving treatment for a mental illness or SUD, a care manager will be involved in their treatment, helping coordinate care between what will likely be many members of a treatment team, helping to identify and find resources for them, providing access and aid in securing resources, and helping in understanding the treatment process.
Support also comes in the form of a friendly ear and having someone who will listen to you. This can be from professionals, therapists, doctors, care managers, or it can be people in your life, friends and loved ones, or from other supports out in the community, like a support group, or an outreach center. For people with a co-occurring disorder, there may be special support groups like AA, focused on people with both a mental illness and an SUD. This provides a lot of support and understanding for people who have been there already and from those going through it now. Finding as much support as possible will go a long way in preventing relapse.
As I stated above, everyone needs support. Loved ones need this too. Please remember caregivers need to take time for themselves. If you’re a caregiver, find places where you have a safe and listening ear. Al-anon and the National Alliance for the Mentally Ill (NAMI) are two wonderful entities that exist to provide support for the friends and family of people with a mental illness or an SUD. This will help in finding relief on difficult days, being able to vent safely, hearing how others have handled similar situations, and learning about the diagnoses, as it may be a first time for a family dealing with a mental illness. Seek out support.
Trying to describe the experience and worldview of someone with schizophrenia and/or a substance use disorder—as they are oftentimes hard to distinguish between—will be difficult. The schizophrenic view will come across much differently from that of most people and appear rather alien in nature. I say this not to be demeaning or discouraging, as treatment options and hope are often readily there, but to remind us all of our own humanity. Being alone and scared in a strange and foreign place can be a striking description with which we can all empathize. That is how some live every day of their lives. Remember that, and remember that hope is always here.
National Institute of Mental Health - Schizophrenia