This condition typically begins as substance-induced psychosis, which is a break from reality following the taking of or withdrawing from a substance. Research finds that over 25% of people who have a substance-induced psychotic episode will later be diagnosed with schizophrenia.
This article will discuss the relationship between drug-induced psychosis and schizophrenia and how it’s treated.
Causes
Ingesting or withdrawing from certain medications, drugs, and alcohol can cause episodes of psychosis. However, not everyone who has an episode of drug-induced psychosis will later be diagnosed with schizophrenia. It is important to differentiate between the two conditions. Schizophrenia is a persistent and complex condition with many factors contributing to its causes.
Research does indicate that the type of drug a person takes before an episode of substance-induced psychosis can be a predictor of whether they will later develop schizophrenia.
One review found that cannabis, hallucinogens, and amphetamines have the highest rates of substance-induced psychosis that later transitions into schizophrenia.
Opioids, alcohol, and sedatives have slightly lower rates of producing this transition, but they are still associated.
Cannabis
The use of cannabis and schizophrenia are linked, but it has been challenging for researchers to tease out the precise relationship between the two.
A recent review found some evidence that cannabis can have a small effect on causing schizophrenia as well as exacerbating symptoms of existing schizophrenia. However, there was also evidence that the cannabidiol (CBD) component of cannabis may have some therapeutic benefit for existing schizophrenia.
As cannabis becomes legal in more states, more research will likely be done.
Risk Factors
Substance-induced psychosis is a significant risk factor for later developing schizophrenia. A 2017 study tracked the number of people who were first admitted with substance-induced psychosis and later transitioned to schizophrenia over a 15.5 year period.
In the study, the risk factors for developing schizophrenia also included:
Male genderYounger ageLonger first hospital admission
There is also a large genetic factor with schizophrenia. A person may be at greater risk of developing schizophrenia if they have close relatives with the condition. Some research has found that there are shared genes that increase a person’s risk of both methamphetamine-induced psychosis and schizophrenia.
Symptoms
The primary symptoms of schizophrenia are
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Hallucinations Delusions Disorganized speech A combination of all three
To be diagnosed with schizophrenia, a person must experience at least one of these three symptoms. There can be many other symptoms present, including a flat affect and catatonic behavior, and each person will present differently.
Delusions
A delusion is a fixed, false belief that is not based in reality. Examples of delusions common in schizophrenia are believing that others are out to hurt you, believing that others can hear your thoughts or are putting thoughts into your head, and believing that you have extra powers or magic.
Hallucinations
A hallucination is a sensory experience that does not exist in reality. They can be auditory (sound), visual (sight), tactile (touch), olfactory (smell), or gustatory (taste). Common hallucinations include seeing people that aren’t there and hearing voices.
Length of Episodes Last
Acute episodes of psychosis can last hours, days, weeks, or months, and in many cases may require hospitalization to ensure the person’s safety.
Stopping drug use does not necessarily mean that symptoms will immediately cease, but it is the first step.
One study of people hospitalized with substance-induced psychosis found that 60% of participants’ psychosis symptoms ceased within one month of stopping drug use, 30% within one to six months, and 10% for more than six months.
Diagnosis
Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose psychiatric conditions such as schizophrenia.
Physiological testing cannot diagnose schizophrenia, but it may be used to rule out other conditions. These tests can include:
Computerized tomography scans (CT scans) or magnetic resonance imaging scans (MRI) to identify brain lesions Blood or urine tests to identify substances that can induce psychosis, such as cannabis, LSD, or methamphetamines
Treatment
Treating schizophrenia can help limit the number of acute psychotic episodes a person experiences and increase their engagement and functioning in daily life. However, some people with schizophrenia are reluctant to get treatment or they have no insight into their delusions or hallucinations.
In the case of drug-induced psychosis, or schizophrenia that is worsened by the use or withdrawal from certain substances, addressing substance use is an additional part of the treatment regimen. Managing withdrawal is potentially one of the first steps.
Hospitalization
Hospitalization can be an essential part of a person’s treatment and recovery from a drug-induced episode of psychosis or an exacerbation (worsening) of schizophrenia. During these episodes, a person either may be a danger to themselves through potential drug overdose or by simply not caring for themselves because of extreme agitation, delusions, and hallucinations.
Close-contact medical treatment in a hospital setting can help the person manage the psychosis symptoms and their withdrawal from substances. It also can form a comprehensive discharge plan for ongoing treatment, psychotherapy, community support, housing, and rehabilitation.
Medication and Psychotherapy
Antipsychotics are used in the treatment of schizophrenia. These include both “typical” antipsychotics, like Thorazine (chlorpromazine) and Haldol (haloperidol), and “atypical” antipsychotics, like Risperdal (risperidone) and Clozaril (clozapine).
For people experiencing psychosis as a result of substances use, additional medication may be used to help a person withdraw from those substances.
Psychotherapy (talk therapy) can also be an important part of the patient’s treatment plan.
Outlook
Schizophrenia is a chronic, lifelong psychiatric condition. There is no cure for schizophrenia, although there are effective treatments available that can help manage symptoms and avoid triggers.
Throughout their life, a person with schizophrenia will experience ups and downs. This can include periods of remission, as well as acute episodes of psychosis, in which their schizophrenia symptoms worsen. In some cases, this is preceded by substance use or withdrawal.
A Word From Verywell
Substance use disorder, drug-induced psychosis, and schizophrenia can all be closely associated. It may be that substances are a trigger exacerbating symptoms of schizophrenia, that people use substances to cope with schizophrenia symptoms, or that environmental and genetic factors predispose a person to both conditions. Research is ongoing, but all three conditions are complex, and each person’s case is unique.
If you or someone you love is experiencing symptoms of psychosis, or drug or alcohol abuse or withdrawal, seek medical care to keep safe and achieve a possible diagnosis.
