Schizophrenia
and Substance Use
Disorders
How do Thought Disorders and
Substance Use Disorders
Interact?
Topic Areas
I.
Description of Thought Disorders
II.
Influential Factors on the Illness
III. Effect of Substance Use
IV. Implications for Recovery
I.
Description
of Thought
Disorders
How is it decided
if someone has a
“thought disorder?”
Diagnostic Criteria for Schizophrenia*
A. Characteristic symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period:
(1) delusions
(2) hallucinations
(3) disorganized speech
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or
avolition
B. Social/occupational dysfunction: One or more areas of
functioning such as work, interpersonal relations, or self care
are markedly below the level achieved prior to the onset.
C. Duration: Continuous signs of the disturbance persist for at least
6 months.
E. The disturbance is not due to the direct physiological effects of a
substance or a general medical condition.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 312
Diagnostic Criteria for
Schizoaffective Disorder*
A. An uninterrupted period of illness during which, at some time,
there is either a Major Depressive Episode, a Manic Episode, or
a Mixed Episode concurrent with symptoms that meet Criterion
A for Schizophrenia.
B. During the same period of illness, there have been delusions or
hallucinations for at least 2 weeks in the absence of prominent
mood symptoms.
C. The disturbance is not due to the direct physiological effects of a
substance, or a general medical condition
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 323
Diagnostic Criteria for
Substance-Induced Psychotic Disorder*
A. Prominent hallucinations or delusions.
B. There is evidence from the history, physical examination, or
laboratory findings of either (1) or (2):
(1) the symptoms in Criterion A developed during, or within a
month of, Substance Intoxication or Withdrawal
(2) medication use is etiologically related to the disturbance
D. The disturbance is not better accounted for by a Psychotic
Disorder that is not substance-induced.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 342
Terms and Definitions

“Positive” symptoms (“in addition to”
what was experienced before the
illness) include;
– Delusions
– Hallucinations (Auditory, Visual, etc.)
– Disorganized Speech
– Bizarre Behavior
Terms and Definitions

“Negative” symptoms (“taken away
from” what was experienced before the
illness) include;
–
–
–
–
–
Alogia
Affective Blunting or Flattening
Avolition
Anhedonia
Attentional Impairment
Delusions
False beliefs
 Affects the “Inference” system of the
brain
 (ex.) “Conspiracy theories” are common

Hallucinations
False perception
 Affect the “Perception” system of the
brain
 Auditory hallucinations are most
common
 Any of the 5 senses may be involved

Disorganized Speech
Affects the “Language” system of the
brain
 (ex.) Word salad is a jumble of
words/phrases that lacks
comprehensible meaning;
 (ex.) Tangentiality is a style of speech in
which a person replies to questions in
an irrelevant, “off the topic” manner).

Bizarre Behavior

Affects the “Behavior-inducing” systems
of the brain

(ex.) Ritualistic behaviors – may
represent “normal” responses to the
“abnormal” stimuli of active delusions or
hallucinations
Alogia

the inability to organize one’s thoughts
and express them fluently
Affective Blunting or Flattening

“Flat affect”

A deficiency in the ability to express a
full range of emotion

May be expressed in a monotonal
voice, a “poker face,” or a
“schizophrenic stare”
Avolition

The inability to initiate a behavior, or
carry it out

(exs.) Withdrawal, apathy, decreased
energy, decreased motivation
Anhedonia

The inability to experience pleasure or
enjoyment

May result in the discontinuation of
hobbies or recreational activities
Attentional Impairment

Difficulty in focusing attention

Can lead to inability to complete tasks
or activities that require focused
attention
II. Influential Factors
Family History (Genetic) Factors

Individuals with schizophrenia are more
likely to have relatives with psychiatric
illness (or substance use disorders)

Indicates a genetic vulnerability to
psychiatric illness (and substance use
disorders)
Supersensitivity Model
Biological vulnerability + environmental
stress = precipitate the onset of the
disorder or trigger relapses
 Medications decrease vulnerability
 Substance use increases vulnerability

III. Effect of
Substance Use
Alcohol Use

Combining Alcohol and antipsychotic
medication can cause life-threatening
oversedation
Cocaine Use

Cocaine abuse can damage the brain
and cause psychotic episodes to occur
Marijuana Use

Marijuana use can contribute to the
frequency and intensity of psychotic
episodes
– More severe positive symptoms
– Quicker psychiatric relapses & re-
hospitalizations
– Earlier age of onset
IV. Implications for
Recovery
Special Considerations
More likely to develop addiction with
recreational use.
 Many clients report using substances to
facilitate social interactions with peers.

Principles of Integrated Treatment*
Integration
 Comprehensiveness
 Assertiveness
 Reduction of Negative Consequences
 Long-Term Perspective
 Motivation-Based Treatment
 Multiple psychotherapeutic modalities

* Mueser, K.T. et al. (2003). Integrated Treatment for Dual Disorders. Guilford Press: Canada. p. 16-33