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Dealing with Substance Use in Schizophrenia

2018-09-07T13:22:38+00:00 March 16th, 2018|Schizophrenia|0 Comments

Did your family member use street drugs long before they were diagnosed with schizophrenia? I know mine did. In the beginning, I thought the drugs were causing the odd behaviors I was noticing. I was trying to make sense of what was going on and actually hoped it was due to drug abuse. After all, I knew people with addicts in the family…. But I sure as heck did not know anyone with schizophrenia in the family… read more.

Of course it didn’t take long for me to realize drugs weren’t the cause of my family member’s disturbing actions. He had schizophrenia. Had it been the drugs, his symptoms wouldn’t have lasted as long as they did. He wouldn’t have continued to get sicker and sicker.

The ER doctor that treated him during his first psychotic break told me she suspected schizophrenia. I was in shock and disbelief. After he spent a few days in a psychiatric facility, his diagnosis was modified to schizoaffective disorder. In the end, it didn’t matter that much; I soon learned that specific diagnoses of serious brain disorders on the psychosis spectrum will change through the course of the illness. I bet many of you have experienced that with your family member, too.

In the beginning, my family member refused to give up drugs because he thought they helped him. His doctors clearly told him that he needed to stop using, but he was defiant and didn’t realize that his illicit drug use, especially of psychoactive drugs like THC, LSD, and mushrooms, was making reliable diagnosis more difficult.

I’m not a doctor but even I can see how hard it must be to properly diagnose a brain illness when drug use is present. After eight years I’m still frequently unable to tell if my family member’s psychosis is a symptom of his drug use or his schizophrenia.

According to the National Institute of Mental Illness, more than half of those diagnosed with serious mental illness also suffer from co-occurring (or comorbid) substance abuse issues. This is sometimes also referred to as dual diagnosis. But regardless of the terminology, the meaning is the same: your loved one has a serious brain disorder and is a substance abuser. And he’s not alone. Many people with treatment-resistant schizophrenia find relief by self-medicating with street drugs. Through drug use they may achieve immediate respite but the rest of us know there are serious consequences for that temporary reprieve.


  • The more severe the mental illness, the more likely your loved one will use street drugs.
  • Males between the ages of 18 and 44 are at greatest risk.
  • Alcohol, marijuana and methamphetamine are the most common drugs (ab)used.
  • Stress is a huge trigger, as is loneliness.
  • Too often, people with schizophrenia are shunned by their typical friends, but are accepted by other drug users. This is where they believe they find acceptance and friendship.

At this point, I can usually tell whether my loved one has been using drugs or not. His drug of choice is meth right now. This terrifies me. He goes to a homeless camp, uses, and then comes home until the drug has run its course. For a while he’d use a couple times a month, then once a week, then a couple times a week. It’s so difficult to help him understand the harm he’s doing to himself. He tends to “go inside his head” for the first couple of days. Then he sleeps. The next day he is increasingly agitated and angry. He isn’t dangerous to people, but he sure knows how to punch holes in walls and doors! (I’ve become pretty good at these repairs—a topic for a future blog!) Then it starts again.

But something was different this week. I’m not sure if his dealer cut him off, or what. He came home quite angry with me. The homeless men had apparently told him that I went to their camp and caused trouble. Wow. I would be too frightened to do that! Besides, I have a broken leg at the moment and can’t drive. I explained this to my family member and he looked confused. I used the opportunity to clearly explain that the drug users he thinks are his friends had obviously lied to him.

He didn’t use meth that day, but something was different. He didn’t sleep and seemed more distant than usual. I think that the confrontation with his dealer set off an episode of psychosis. As I said earlier, it can be hard for me to tell the difference sometimes but he seems like he’s more in the throes of psychosis right now than drugs.


It was a little more than three years ago when my family member first started using meth. Fortunately, I stumbled upon MyHealios and I signed up for twelve sessions. During those sessions my coach and I worked on the drug issue. She helped me partner with my family member to learn why he used drugs. She showed me how important it was not to judge him or get upset about anything he shared with me. It was hard at first and I often ended conversations with him early so that I wouldn’t get upset. But I gained many useful insights.

I learned that he had been interested in using marijuana (primarily) but that the local kids who sold him the marijuana had started offering him meth instead. Clever young salesmen with their ‘upsell’ skills! They won and soon he had fully moved-on to meth. My coach helped point out that my family member had been seeking marijuana from illegal sources. In California, we have legal ‘medical’ marijuana dispensaries. Trying to help keep my loved one on the right side of the law and away from street drugs, I offered to take him to get a medical marijuana card and told him that I’d pay for marijuana from a dispensary.

This turned out to be an excellent technique. We went together to the dispensary and got him marijuana. After he used, I’d casually point out symptoms I noticed. I’d say something like, “It seems like you were really scared for a little while. I wonder what could have caused that?’

After three times, he was done with marijuana. He stayed drug-free for almost three years subsequently.

Obviously, as you’ve learned from reading this far, he’s using again. I thought things were looking up. He’s finally found a proper med and proper dose that makes him feel like socializing. Unfortunately, the only people who will socialize with him now (besides family) are drug users. So, he uses… and refuses to use marijuana, so I’m back where I started. How do I get him to quit this time? I’m trying different techniques I’ve learned from MyHealios training. I’m making some progress and will never give up.

I hope this information is helpful to you. Please comment with questions, suggestions or other information. For information about how to receive caregiver-centric support, stress-management, and disease-specific tips and techniques (from the convenience and privacy of your own home via telehealth), visit MyHealios.

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