What’s the Link Between Schizophrenia and Alcohol?

Research from 2019 suggests that people who have schizophrenia are three times more likely to engage in heavy alcohol use compared with the general population.

A 2018 review of 123 studies found that 24.3% of people with schizophrenia have had AUD at some point in their lives.

Overall, people living with schizophrenia typically drink alcohol to temporarily feel better.

They may drink alcohol to seek relief from feelings of hopelessness or to help relieve symptoms they may experience.

While the exact mechanisms contributing to increased substance use in people with schizophrenia are unknown, there are likely several contributing factors.

It’s believed that genetics, environmental factors, and dysfunction in the brain’s reward system may all play a role.

In addition, people with schizophrenia are at greater risk of poverty, poor social functioning, poor social environments, and reduced cognitive development. These factors can further increase the risk of a substance use disorder.

A 2018 research article suggests the genetic factors that contribute to a person’s chances of schizophrenia may also make them more vulnerable to substance use disorder.

Researchers in one genome-wide analysis from 2021 found a genetic overlap between alcohol use behaviors, schizophrenia, and bipolar disorder.

For instance, abnormalities in the brain’s reward system (commonly seen in both schizophrenia and substance use disorder) may lead adolescents who may experience psychosis to use alcohol at greater rates than other teens.

The alcohol use itself may trigger the onset of schizophrenia or lead to continued substance use.

According to a 2019 research review, one study found that out of 404 participants, 36.4% reported having had AUD before their first episode of psychosis.

The use of alcohol often leads to severe effects for people with schizophrenia, but many find it difficult to quit drinking. However, support is available to start and maintain recovery.

Among people with schizophrenia, AUD is linked to a greater risk of:

• depression
• suicide
• not following treatment (e.g., not taking medication)
• chronic physical problems
• housing instability
• aggression or violence
• incarceration
• hospitalization

Symptoms of psychosis can arise from acute alcohol intoxication, alcohol withdrawal, or long-term alcohol use.

These symptoms may either indicate a condition known as “alcohol hallucinosis” or the onset of a primary psychotic disorder, such as schizophrenia.

In alcohol hallucinosis, symptoms of psychosis are directly related to alcohol use. They resolve when alcohol consumption stops.

It’s similar to schizophrenia in that it involves hallucinations, paranoia, and fear, but it’s considered a separate and relatively rare condition.

In contrast, alcohol can also trigger first-episode psychosis if there are increased chances of developing schizophrenia.

Research suggests that people with a substance use disorder have an earlier age of onset of schizophrenia.

A medication regimen that addresses both psychosis and AUD is the typical treatment for these conditions. Other types of therapies may be used as well.

Specific treatment depends on whether the psychosis was temporarily induced by alcohol or if you have a primary psychotic disorder with AUD.

Treatment for alcohol-induced psychosis

If you seek emergency care for alcohol-induced psychosis, healthcare professionals will need to first determine whether the psychosis is temporary or if alcohol use triggered the onset of schizophrenia.

Treatment for alcohol-induced psychosis requires a supportive environment, sometimes with short-term antipsychotic treatment. Abstaining from alcohol following treatment can reduce the risk of alcohol-induced psychosis coming back.

Researchers from a 2019 study suggest that once you become sober and the alcohol withdrawal period is over, symptoms of psychosis typically resolve.

However, 25% of psychosis cases persist, they report, resulting in a diagnosis of schizophrenia spectrum disorder.

Treatment for schizophrenia and AUD

If you have schizophrenia and co-occurring AUD, treatment typically includes long-term antipsychotic medication use, psychosocial interventions, and medication for alcohol dependence. It’s very important that both conditions are treated simultaneously.

In a 2019 study with people with schizophrenia and AUD, researchers found that participants treated with naltrexone (a medication used to treat AUD) reported far fewer drinking days, fewer heavy drinking days, and less craving compared with placebo.

When it comes to schizophrenia medication, the newer class of antipsychotic drugs — called “atypical” or “second-generation” antipsychotics — appear to work better for alcohol dependence than the older “first-generation” drugs.

Research shows that first-generation antipsychotics don’t appear to reduce alcohol use. They may even increase substance use and craving in people with schizophrenia and AUD. Rather, long-acting injectable formulas of atypical antipsychotic drugs may be preferred.

Some research from 2019 supports the use of clozapine, an atypical antipsychotic, for people with both schizophrenia and AUD.

Results show that a larger proportion of people treated with clozapine achieved remission from AUD, compared with those taking another antipsychotic drug. Participants taking clozapine also had lower relapse rates a year later.

Psychosocial interventions for schizophrenia and AUD

Psychosocial interventions address a person’s social and cultural environment, and target any problematic psychological and behavioral patterns.

Two well-studied interventions for people with schizophrenia and AUD include contingency management and assertive community treatment (ACT).

Contingency management

Contingency management is a type of behavioral therapy in which a person is rewarded or incentivized for positive behavior. It’s been shown to be effective for people with schizophrenia and AUD.

This type of therapy involves agreed-upon, immediate, tangible rewards for positive behaviors, such as abstinence from alcohol.

One 2017 study found that people with severe mental health conditions and AUD who participated in a contingency management treatment were 3.1 times more likely than those in a control group to pass an alcohol urine test.

Assertive community treatment (ACT)

Assertive community treatment (ACT) is the most widely tested model of community care for people with severe mental health conditions. ACT has been shown to help people with co-occurring schizophrenia and AUD.

The goal is to help people with severe mental health conditions continue to live in their community of choice.

This intervention involves a treatment team, typically a psychiatrist, social workers, nurses, occupational therapists, and peer support. There is a low participant-to-staff ratio.

Clients are assisted with physical and mental health care and substance use treatment. They also receive support with housing, daily living activities, employment, and financial management.

Visits are provided at the client’s home or another place of their choosing.

Alcohol use disorder (AUD) is commonly seen in people with schizophrenia. If you or someone you love has schizophrenia and AUD, know you’re not alone and support is available.

Consider speaking with a healthcare professional to discuss treatment options. There are many effective interventions that can help you on your journey to wellness.