SOD Chapter 2 - Subchapter 4 - schizophrenia.life

2.4. DOES SUBSTANCE USE IMPACT THE EFFECTIVENESS OF SCHIZOPHRENIA TREATMENT?

Substance use can turn the already complex task of treating schizophrenia into an even more complicated puzzle. Evidence suggests that individuals with dual schizophrenia do not experience the same benefits from treatment as those who do not use substances.

This situation aggravates by lower adherence to treatment programs, as they are more likely to miss clinic appointments and day program sessions and are less compliant with prescribed pharmacotherapy.

Having both schizophrenia and substance use issues creates a challenging landscape for effective management, often leading to:

Why is treatment adherence so vital?

Effective treatment for dual schizophrenia must address biological, psychological, and social factors, with antipsychotic medication playing a central role.

Staying on track with medication – taking the right dose at the right time – is essential for managing symptoms, preventing relapses, and improving life expectancy. On the contrary, poor adherence, such as missing doses, taking incorrect amounts, or stopping medication without medical guidance, can weaken treatment effectiveness and increase the risk of relapse.

Relapse is a major concern, especially since experiencing one makes future relapses more likely. Medication non-adherence is a key predictor of relapse, particularly the first one.

Other factors, such as coexisting medical or psychiatric conditions and substance use disorders, can also contribute to relapse by either disrupting medication routines or worsening symptoms.

The type of care provided plays a critical role in long-term stability.

For individuals with dual schizophrenia, treatment must target both schizophrenia symptoms and those related to substance use disorder.

Tailoring therapy to each patient’s unique needs increases the likelihood of adherence, leading to better outcomes and improved overall well-being.

Do addictive substances relieve symptoms of schizophrenia?

Some addictive substances interact with the brain in ways similar to psychoactive medications, temporarily easing certain schizophrenia symptoms.

For example, nicotine and cannabidiol (CBD) may provide some symptom relief in schizophrenia. However, we must take into account that nicotine is usually consumed with tobacco in cigarettes, and CBD is usually consumed in “joints” with high Tetrahydrocannabinol (THC) levels. These other substances, as well as the act of smoking, can lead to very negative effects.

Research suggests that opiates may reduce some psychotic symptoms, while stimulants could help with negative symptoms of schizophrenia. However, both substances come with serious risks and potential harm.

Alcohol use is also common among people with schizophrenia, often as a way to cope with anxiety or psychotic symptoms rather than experiencing these symptoms as a result of drinking. Still, alcohol can worsen overall health and stability.

This perspective does not aim to encourage substance use, but rather promote understanding and avoid blaming patients, suggesting the need to adopt “substitution therapy” or “replacement therapy” in many cases.

Why do patients with schizophrenia often hide their drug use?

A study by the National Institute of Mental Health (NIMH) in the USA looked into this issue. Over a thousand participants with schizophrenia completed self-assessment questionnaires about their use of cannabis, cocaine, and amphetamines. They were also given lab tests to confirm their answers. The results were eye-opening: 38% of patients tested positive for these drugs, and more than half of them had not admitted to using them.

Imagine how much higher the numbers might be if the study had also included tobacco and alcohol!

This is likely because patients living with schizophrenia fear judgment and blame for having a substance use disorder (SUD).

It’s crucial to understand that SUD is a mental disorder, not a choice.

We need to emphasize compassion and understanding in treating these individuals, recognizing that they are dealing with complex and overlapping mental health challenges.

Effective TRIO for managing dual schizophrenia

The combined impact of schizophrenia and substance use disorders must be addressed with care and expertise.

To prevent negative outcomes, it is crucial to implement effective prevention, individualized treatment, and targeted rehabilitation strategies.

Unfortunately, people with dual schizophrenia often face stigma and discrimination.

They are frequently told to “just stop using substances” without being offered real support – an approach as unrealistic as expecting someone to simply stop experiencing psychosis.

In treating substance use disorders, adopting “harm reduction” strategies is essential. However, it’s even better to use less stigmatizing terms like “substitution therapy” or “replacement therapy” to create a more supportive environment.

Another downside is the “wrong door syndrome,” where patients might get shuffled between different treatments for schizophrenia and substance use disorders, rather than receiving coordinated therapy. This can lead to fragmented care and less effective treatment.

People with dual schizophrenia and their families deserve treatment rooted in modern neuroscience and precision psychiatry. We must move away from outdated, moralistic views and embrace a comprehensive approach focused on true recovery and support.

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