What’s the Link Between Alcohol and Schizophrenia?

People who have schizophrenia can face a number of challenges: getting a diagnosis, staying on track with treatment, and learning to live with a mental illness.

Schizophrenia also carries a higher chance of misusing drugs and alcohol. Scientists think it’s due to your genes, shared changes in brain pathways, or as a way to cope with the symptoms and side effects of the illness.

Schizophrenia and Alcohol Misuse

Researchers have mostly studied the effects of cannabis and nicotine on people with schizophrenia. But they’ve also found that other things that alter your nervous system and mood (called psychoactive substances), like alcohol, can trigger first-time psychosis. This is especially true for young people who are at higher risk of schizophrenia, such as those with a family history of the condition. Alcohol also affects the brain’s reward systems, and research links changes to this area of the brain with schizophrenia.

Alcohol misuse alone over long periods can cause psychotic symptoms such as hallucinations, which is when you see, feel, hear, or smell something that isn’t there. “These symptoms can mimic or overlap with symptoms of schizophrenia and appear to ‘trigger’ a psychotic episode,” says Kamal Bhatia, MD, a psychiatrist at Baltimore’s Sheppard Pratt, a nonprofit provider of mental health, substance abuse, and other services.

People with schizophrenia are also more vulnerable to substance abuse. One large study shows that 47% have problems with drugs or alcohol, compared with 16% of people without the condition. Other recent research suggests that this group is three times more likely to drink alcohol. In fact, it’s the second most common psychoactive substance that people with schizophrenia use.

Experts have a few theories about why this is. One is that you’re more likely to have schizophrenia or misuse alcohol if you have a family history of these conditions. Researchers are also looking at the link between biomarkers (molecules in your body that suggest disease), alcohol misuse, and schizophrenia. Others think some people misuse alcohol to ease the symptoms of psychosis or side effects of antipsychotic medication.

Many people with schizophrenia hear disturbing things that aren’t really there, become paranoid, have trouble connecting with others, and have cognitive disabilities, says David Goldsmith, MD, assistant professor in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine. “There’s long been a theory that patients may abuse substances, including alcohol, to help self-medicate.”

But many people misuse alcohol before getting schizophrenia, which suggests that self-medication isn’t always the link. Plus, if you have this condition and rely on alcohol, you’ll actually make your symptoms worse, not better.

Schizophrenia and Alcohol Warning Signs

Many people with schizophrenia go through what Goldsmith calls a “downward social drift.” They may end up homeless, isolated, or with legal problems, and they’re more likely to need emergency services. “Unfortunately, our jails and prisons are the largest mental health providers in our country right now.”

People with mental health issues who heavily abuse drugs and alcohol tend to have worse health outcomes and repeated relapses because they may not stick with a treatment plan.

If you’re worried about someone you love, watch for changes in mood and behavior such as:

Treatment for Schizophrenia and Alcohol Misuse

Long-term alcohol misuse and mental illness are lifelong conditions, just like diseases such as high blood pressure or diabetes. “As with other conditions, these too can be managed by getting the right help at an early stage,” Bhatia says. “Suffering in isolation isn’t healthy or the only choice available.”

He adds that getting help is even more crucial during the COVID-19 pandemic, when people are more isolated and may miss regular checkups. The first step is contacting your family doctor, who can offer treatment options or refer you to a mental health professional. The sooner you get treatment and stick with it, the more likely you are to get better.

Treatment centers can be hesitant to take on the challenge of treating people who have both schizophrenia and problems with alcohol, Goldsmith says. But since alcohol misuse and schizophrenia often happen together, it’s important to treat both conditions at the same time.

Dual-focused treatment lowers your chance of a relapse and improves your quality of life and the odds that you’ll continue to take your medication. Treatment may involve individual or group therapy along with prescription medication. If you can’t see a doctor, talk to family and friends. They can also watch for changes in mood and behavior.