Navigating Dual Diagnosis: Treating Schizophrenia and Substance Use Disorder

If you have both schizophrenia and a substance use disorder (SUD), you may wonder whether you can get treatment for both. Fortunately, you don’t have to choose between mental healthcare and SUD treatment. Telling your healthcare team about your substance use can help them build a treatment plan that addresses both conditions.

This guide explains what dual diagnosis treatment can involve, how to talk with your psychiatrist, and what to ask when you’re seeking care.

Understanding Dual Diagnosis

Healthcare providers use the term dual diagnosis when someone has a mental health condition, such as schizophrenia, along with a SUD. You may also hear this referred to as co-occurring disorders.

Having both schizophrenia and a SUD doesn’t necessarily mean that one caused the other. Substance use can occur before, after, or around the same time as schizophrenia symptoms, and it can sometimes be hard to tell which came first.

Certain factors may also play a role in either condition, including genetics, stress, and traumatic experiences. But these factors can affect people differently, so there may not be one clear reason why both conditions develop.

How Can the Conditions Affect Each Other?

Some people with schizophrenia use alcohol or drugs to help cope with hallucinations (seeing or hearing things that aren’t there), trouble sleeping, and medication side effects. This is referred to as “self-medication,” which is the practice of treating oneself with medication or substances without the guidance or prescription of a healthcare professional.

Substance use can also make schizophrenia more difficult to manage. It is linked to poorer treatment outcomes, can worsen psychotic symptoms, and can also make it harder to take medication as prescribed. Some substances can even cause psychosis.

When both conditions are present, it can be hard to tell what’s behind a change in symptoms. Some substances, and withdrawal from them, can cause hallucinations or delusions (strongly held false beliefs) that can look a lot like symptoms of schizophrenia.

Integrated Treatment for Both Conditions

Dual diagnosis treatment can include several types of support, depending on your symptoms, substance use, medical history, and the care available where you live.

Coordinated Mental Health and Addiction Care

A dual-diagnosis program puts your schizophrenia and substance use disorder care under one healthcare team. That team may include a psychiatrist, an addiction specialist, a therapist, and a case manager.

When your healthcare team coordinates your care, they can consider your substance use alongside your medications, daily life, and physical health. This can make it easier to notice when one condition is affecting the other and adjust your care.

But if you receive mental health and addiction care through separate programs, ask whether your providers can share information with your permission to help coordinate care.

Medications

Medication may be part of treatment for schizophrenia, SUD, or both. Antipsychotic medications can help manage psychotic symptoms such as hallucinations and delusions.

Depending on the substance involved, other medications may ease withdrawal, reduce cravings, or lower the risk of returning to substance use. For opioid use disorder, approved medications include buprenorphine, methadone, and naltrexone.

However, some medication combinations can increase sedation or other risks, so it is best not to stop, start, or change a medication on your own. Ask your psychiatrist or substance use treatment provider how your medications can work together safely.

Therapy and Behavioral Support

Psychotherapy can help you build coping skills and give you strategies for managing substance use. Depending on your situation, treatment may include individual, family, or group therapy.

Approaches like cognitive behavioral therapy (CBT) can help you work toward reducing or stopping substance use. Motivational interviewing can help build your confidence to make changes and stay engaged in treatment.

Treatment doesn’t have to address every concern at once. Your healthcare team can help you choose what to work on first, and your plan can shift as you become more ready for change.

Peer, Family, and Community Support

Recovery doesn’t have to happen through medical appointments alone. Support groups can connect you with people who understand what it’s like to live with mental health and substance use challenges, which may help you feel less alone.

Groups like Dual Diagnosis Anonymous support people living with a dual diagnosis like schizophrenia and SUD. Other groups, such as Alcoholics Anonymous, focus on alcohol use. If a group isn’t a good fit, it’s OK to try another.

When you’re managing a dual diagnosis, family members or other trusted people can help you stay connected to your care. They may help you get to appointments, remember medications, notice changes in your symptoms, or manage day-to-day tasks.

A case manager can also help coordinate appointments, connect you with housing or community resources, and address barriers that make treatment harder to access, such as transportation or insurance.

How Caregivers Can Support Someone With Both Conditions

Supporting someone with schizophrenia and an SUD can bring worry, frustration, and uncertainty, especially when you want to help but can’t make decisions for them. But you can offer support while respecting their choices.

For instance, you can ask about their substance use without blaming or shaming them. Ask about their goals rather than telling them what to do, and respect their decisions about their care, even when you disagree.

The LEAP method (listen, empathize, agree, partner) can help when the person you’re caring for doesn’t feel ready to seek treatment. You can also offer help with everyday tasks, such as rides to appointments or help finding treatment programs.

You can pay attention to changes in their mood, behavior, substance use, or symptoms, as well. If you notice changes that concern you, encourage them to talk with their healthcare team and offer to help them get care.