SOD Chapter 1 - Subchapter 4 - schizophrenia.life

1.4 FROM HABIT TO DISORDER: SUBSTANCE USE AND ITS SPECTRUM

People can be affected by substance use in various ways. Young adults commonly engage in experimentation with substances for recreational purposes. Although not favorable, moderate, and infrequent alcohol consumption and substance use are widely practiced and may not necessarily lead to problems for the average person.

On the contrary, excessive substance use denotes the pattern of alcohol consumption and/or drug use that predisposes the individual to negative consequences.

Binge drinking can be defined as the consumption of 4 units of alcohol for women and 5 for men within the span of a 2-hour time frame. An example of substance misuse associated with binge drinking is reaching a blood alcohol concentration of 0.98 g/dL, which can heighten the risk associated with health issues, and cognitive and interpersonal problems for a short term, as well as for a longitudinal period.

The regular consumption of marijuana (cannabis) is a further example of substance misuse which can cause the user an increased risk of cognitive impairment and health problems.

Substance use: consequences that can’t be ignored

The harmful consequences of using substances can vary from mild to severe.

Even though it can appear that little impact is experienced each time a substance is used, there will likely be a build-up of the harmful consequences over time.

A substance use problem can develop when someone continues to use substances despite the experience of harmful consequences.

Harmful consequences of substance use can affect every aspect of one’s life, including:

causing injuries while under the influence
experiencing anxiety, depression, or irritability
having trouble with clear thinking
experiencing blackouts
having relationship problems
choosing to spend money on substances rather than life essentials
having legal problems due to substance use
experiencing loss of hope and feelings of emptiness

Despite their awareness of having a substance use problem, some people may continue to use and may not be able to stop even if they so desire. This can manifest in them using over their intended quantity in situations where they had no intention to use.

Why is it hard to break free from substance use?

One reason it’s tough to change behaviors around problematic substance use is because that the immediate effects often feel good. The user might experience a boost in mood, increased confidence, and a temporary escape from their problems. The negative consequences, on the other hand, might not show up for a long time. When someone uses substances to escape their feelings or change their mood, it can lead to addiction, which is both harmful and hard to break.

If substance use continues, especially in heavy amounts, it can cause changes in the body and brain. This can lead to withdrawal symptoms when trying to quit after developing a physical dependence.

These changes help explain why people may experience craving for substances even after long periods without using, and why they might return to harmful patterns of use.

From use to disorder: understanding the risks

Substance misuse carries the risk of developing into a substance use disorder

The burden of a Substance Use Disorder can include:

using an increasing quantity of the substances over time;
failed attempts to decrease or stop using;
dedicating lengthy amounts of time being engaged with, and/or recovering from the effects of the substance;
sacrificing important occupational, social, or recreational events and activities in favor of using the substance.

Substance use disorders can cause a decline in one’s ability to function, the negative results of which might become evident to individuals only over time.

Double trouble: SUD detrimental impact on schizophrenia

If substance use disorders and mental illness, such as schizophrenia, coexist, they can have a detrimental effect on the clinical course of the illness.

Increased Severity of Symptoms: Schizophrenia with SUDs is associated with more severe positive symptoms (e.g., hallucinations, delusions).

Higher Risk for Suicidal Ideation: Individuals with both schizophrenia and SUDs are at increased risk for suicidal thoughts.

Aggression and Adherence Issues: Higher levels of aggression and decreased likelihood of medication adherence are linked to dual disorders.

Increased Relapse and Hospitalization Rates: Individuals with both schizophrenia and SUDs experience higher rates of relapse and hospitalization.

Interpersonal Conflict: There is a greater risk of interpersonal conflict with family members, providers, and others.

Risk of Homelessness: Those with schizophrenia and SUDs face higher rates of housing instability and homelessness.

Chapter 2 explains in more detail the comorbidity impact on the clinical course of the illness.

Why do individuals with schizophrenia use substances despite the negative impact on their health?

In theory, patients with schizophrenia are most probably attempting, on a brain level, to counterbalance a neurotransmitter imbalance, which is the primary cause of the disease’s symptoms and manifestation.

They might try to achieve this via substances that can deliver pseudo-beneficial effects (the perception of improvement of some symptoms in the immediate period after the use of substances, burdened with the possibility of addiction, sequelae and subsequent health complications).

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