Alcohol and schizophrenia

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    How much alcohol is too much?

    It’s generally accepted that drinking no more than 14 units of alcohol per week – spread over several days – is associated with the least risk to health.2,3   There is no completely safe alcohol limit, however,and while people who drink more than this on a regular basis do not necessarily have a problem with alcohol, they are putting themselves at higher risk for developing chronic health issues.5

    What’s a unit of alcohol?

    A unit of alcohol is 10 ml or 8 g of pure alcohol.

    It’s the amount the average human can process in 1 hour. 2

    The number of units in a drink depends on its strength (alcohol by volume or ABV) as well as its size (e.g., a glass or pint). 2

    Signs that someone may be drinking too much and may have developed alcohol use disorder include:3,6 

    Thinking about alcohol all the time and planning the day around having a drink.

    Feeling compelled to drink and finding it hard to stop once starting.

    Feeling the need to drink when you wake up or soon after.

    Having withdrawal symptoms, such as shaking, sweating, or feeling sick, which stop after having an alcoholic drink.


    Alcohol use disorder and schizophrenia

    Alcohol use disorder is a condition where drinking alcohol causes undue distress or harm to the individual or others.6.7 It can be described as mild, moderate or severe, depending on the importance of alcohol to the individual.6,7  
     
    It’s a condition that may affect up to a quarter of people with schizophrenia at some point in their illness, with studies showing that people diagnosed with psychotic disorder are three times more likely to be heavy drinkers than those in the general population.1 
     
    Regardless of how many people with schizophrenia may be affected, what’s important is the detrimental effect that alcohol use disorder can have on the individual.1 Alcohol may not only increase the risk for psychotic symptoms, depression and suicide, but also increase the risk for chronic physical problems, hospitalization, aggression, violence and even possible imprisonment if left unchecked.1,8


    Alcohol and antipsychotics – not a good combination

    Alcohol can affect how well these medications work, increasing the chance for side effects such as:9

    Drowsiness

    Feeling dizzy

    Difficulty concentrating

    Impaired thinking or judgement. 


    Why do some people with schizophrenia drink too much?

    There are a few theories as to why people with schizophrenia may feel more compelled to drink than others.1,8 One popular idea is that people are ‘self-medicating’ and trying to cope with their psychotic symptoms by ‘blunting’ them,8 although there is not sufficient evidence to support this.1
     
    Another theory is that people with schizophrenia can’t help but drink, because it’s down to their genetics.1 Interestingly, recent research has shown that there is a genetic factor called brain-derived neurotrophic factor (BDNF) that may be linked to the co-occurrence of alcohol use disorder in people with schizophrenia.1
     
    Whatever the reason is, finding a way to help people living with schizophrenia moderate their alcohol intake is important both in terms of preventing the development of alcohol use disorder and improving their overall health.


    How can problematic alcohol use be managed?

    The first step in managing problematic alcohol use is perhaps obvious – recognize that help is needed.8 Depending on the severity of the drinking, talking to a general family doctor, community mental health team or a psychiatrist may be beneficial.8  Note that while there are specific support groups for alcohol-related problems, the approach taken may be rather confrontational which may not suit someone with schizophrenia.
     
    Some of the approaches taken to treat someone with alcohol use disorder include detoxification and withdrawal, and psychological counselling. 10 There are also oral and injected medications that can be used to treat and prevent further alcohol misuse; these work by either removing the pleasure obtained from drinking alcohol or make the drinker feel unwell when consuming alcohol.8,10
     
    A combination of approaches may be needed to help someone living with both schizophrenia and alcohol use disorder,together with ongoing support.10  

    References

    1. Archibald L, Brunette MF, Wallin DJ, Greena AI. Alcohol use disorder and schizophrenia or schizoaffective disorder. Alcohol Res. 2019;40(1):arcr.v40.1.06.
    2. NHS. Alcohol units. Accessed December 2021.
    3. Drink aware. Alcohol dependence and withdrawal. Accessed December 2021. 
    4. Frank. Alcohol. Accessed December 2021.
    5. World Health Organization. Alcohol. Accessed December 2021.
    6. National Institute on Alcohol Abuse and Alcoholism. Understanding alcohol use disorder. April 2021.
    7. MedinePlus. Alcohol use disorder (AUD). Accessed December 2021
    8. Living with Schizophrenia. Schizophrenia and alcohol. January 2016. 
    9. Drugs.com. Antipsychotic medications and alcohol interactions. November 2019.
    10. Mayo Clinic. Alcohol use disorder. Accessed December 2021.
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