Schizophrenia and Substance Abuse; Which Came First, the Chicken or the Egg?

Schizophrenia and way Ab custom Which Came First, the Chicken or the Egg? Terry V. Hites Prof. Bramlage ternary Diagnosis / Co-Occurring Disorders December 6, 2008 Schizophrenia and totality hollo which came branch, the chicken or the orb? This is a greatly debated take within families of schizophrenics that step alcohol.In this paper I hope to explore the preponderance of shopping m exclusively use with those that suffer from schizophrenic psychosis, the age of flack and the age of first use, discussion issues, recovery issues, and finally, the issues regarding the high rate of self-destructive thoughts, attempts, and completions within this specific nation of several(prenominal)s. The 2002 National Survey on Drug Use and wellness in the United States ground that over 23% of adults suffering from dear mental illness ill-treated alcohol or a nonher(prenominal) medicines.In the population without a serious mental illness only 8. 2% abused alcohol or other drugs. A mong adults who abused alcohol or other drugs, 20. 4% had a serious mental illness (Cherry, 2007, p. 37). Over 75% of great deal with a co-occurring disorder who were surveyed during treatment reported a archives of childhood physical abuse (p. 38). Interestingly enough, surveys seduce shown that individuals argon pronto willing to address their core abuse but are not so willing to acknowledge their co-occurring mental illness (p. 9-50). The lifetime preponderance of affection use disorders (SUD) in schizophrenic psychosis is close to 50%. heart abuse in schizophrenia is associated with numerous negative consequences, including psychotic relapses criminality, homelessness, unemployment, treatment non- respect, and wellness problems (Potvin, 2007, p. 792). In this population, nerve center abuse is highly prevalent (p. 792) not just used by a few individuals but passel will abuse substances to cope with the negative or positive symptoms of their illness.When looking at the symptoms that they lie with, Potvin goes on to say, addicted schizophrenia patients suffer from more arch depressive symptoms, relative to non-abusing patients (p. 793). Furthermore, the inquiry excessively shows that males experience the depression more gruelling than females (p. 797) the depression scale includes anhedonia, psycho motor retardation, etc. (p. 796). Keith goes on to say, sum abuse affects approximately half of patients with schizophrenia and can act as a barrier to ossification (2007, p. 59). The lifetime prevalence of substance abuse (excluding smoking) in patients with schizophrenia has been estimated to be approximately 35 to 55% (p. 260). In addition to experiencing these more grave symptoms, or potentially also as a result, psychosocial problems such as occupational, housing or financial difficulties and offensive activity are endemic in the dual-diagnosis population Keith asserts (p. 261). When examining the prevalence of the co-occurring disorders, one would be remiss to not gather in the etiology of each. It could be tempting to dissolve that PAS psychoactive substances use exacerbates depressive symptoms in a subgroup of schizophrenia patients, because long-term use of alcohol, hemp and cocaine is associated with depressive symptoms (Potvin, 2007, p. 797). Although these assertions whitethorn be concluded, it is also important to not croak inferences well-nigh causality, and the reverse explanation cannot be ruled out. That is, severe depressive symptoms may lead patients to use PAS, as proposed by the self- medication hypothesis (p. 97). Psychoactive substance use in juveniles and adults is highly correlated with a number of psychiatrical diagnoses, including schizophrenia. Young adults with schizophrenia involve a 3 times high prevalence of substance use disorders (SUDs) than the corresponding age group in the US general population. (Hsiao, 2007, p. 88). While the amount of research data on this age group is limit ed due to studies not addressing them, it is difficult to vulgarize the data collected (p. 88). Alcohol and marijuana were the two about ordinarily abused agents in our sample. This is consistent with population-based studies of adolescents. The onset of substance use preceded the onset of psychosis in all of our subjects with co-occurring SUD and schizophrenia. Therefore, it is doable that substance abuse precipitousd or exacerbated psychosis in these subjects. Epidemiological and neuroscientific evidence call forths that substance abuse, especially cannabis abuse, can precipitate psychosis in vulnerable subjects.Their sample of 50,413 male adolescents who were suspected of having behavioral problems, Weiser et al. found that adolescents who self-reported abuse of drugs at age 16-17 years were twice as liable(predicate) to be hospitalized later for schizophrenia (p. 95). Hsiao goes on to state that, the onset of substance use preceded their reports of psychotic symptoms in 9 0% of the cases (p. 95). In accordance of the research Keith emphasizes that, the onset of substance abuse often occurs before or somewhat the time of onset of schizophrenia.In a study in which 232 patients with first episodes of schizophrenia were interviewed, 62% reported that drug abuse began before the onset of schizophrenia symptoms, and 51% said the same of alcohol abuse. Within this population, 34. 6% of drug abuse and 18. 2% of alcohol abuse began within the same calendar month as the onset of schizophrenia symptoms. In addition, patients with schizophrenia are twice as likely to have had a history of substance abuse at the time of the first episode of schizophrenia than are tidy subjects (p. 260).Keeping all of these early onset of use issues and early occurrences of the illness in mind there is a tremendous amount of barriers between the individual and their recovery. Next we will explore what issues are barriers to their treatment. The realization that co-occurring prob lems are trounce treated with an integrated approach has only recently been recognized by the treatment community states Cherry, (p. 38-39). Universal screening is needed but some barriers stand in the way of its implementation, from training time to building an understructure of clinicians who support everyone being screened, (p. 9). Ultimately, universal screening is as much virtually the attitudes of administrators and clinicians as it is about having a reliable and valid screen to identify co-occurring disorders. Nonetheless, a screen that is quickly administered, easy to interpret and takes little or no training to administer can break down more of those barriers. Even though there are barriers to instituting a screening unconscious process during intake, the importance of screening for concurrent substance abuse and mental health problems is crucial in the effort to provide effective treatment for people with a co-occurring disorder (p. 0). Potvin reminds us in his resea rch that, ideally, depressive symptoms would be measured both during the active phase of substance abuse and after(prenominal) a period of drug withdrawal, to determine whether the observed differences reflect the acute make of PAS or more stable traits (p. 797). Likewise, persons with mental heath or substance abuse disorders may not seek help oneself, at least not in the form of professional treatment (i. e. , psychotherapy, medication), because these treatment options are perceived by the person, family, or social net track down as inappropriate or undesirable (Kuppin, 2008, p. 20). Kuppin goes on to say, these findings offer important insights for furthering our understanding of how we think about the discrepancy between mental illness and substance abuse prevalence and treatment seeking and adherence (p. 124). Research echoes with relapse among individuals in this cross population nonetheless, there are those who investigate options available to improve compliance. umptee n patients with schizophrenia may abuse substances for hedonistic reasons, while others may use them in an attempt to cut out symptoms or distress.Alcohol, in particular, can range to be used more often than illicit drugs, such as opioids or cannabis, though it has also been reported that patients may turn each to alcohol or illicit drugs to alleviate the negative symptoms inadequately treated, or potentially made worse by conventional antipsychotic and the post effect of dysphoria associated with these agents. However, although patients may believe that substance abuse ameliorates symptoms of schizophrenia, data suggest that many of these underlying symptoms may, in fact, be worsened (Keith, 2007, p. 260).Therein lies the problem, trying to prevail on _or_ upon a person that the drug he is using is transgressing him, when all he sees is this drug is the only thing that keeps me from hurting myself or others and in itself that is the lie they tell themselves, they do end up tr ying to hurt themselves, statistics show it. Additionally, statistics show that non-compliant dual-diagnosed patients account for 57% of hospital readmissions, which is an average of 1. 5 admissions per patient each year (p. 261). As schizophrenia is a lifelong illness, it requires long term, uninterrupted treatment to optimize outcomes.The low rate of therapy compliance already associated with schizophrenia can be further compromised when patients are also active substance abusers. Intoxication may impair judgment reduce motivation to pursue long-term goals and lead to a devaluation of the protection offered by antipsychotic medications, resulting in increased hospital readmissions and significantly more severe symptoms (p. 262). Treatment is further compromised when a patient does not fully spoil into his treatment regime and comply with his doctors, counselors, or therapists.Research shows that several different slipway have been developed to try to improve compliance such as p harmacologic methods, case management, and assertive community treatment programs these do help but improved insight and attitudes about schizophrenia has shown to be most helpful for an individual to take ownership for their recovery. Moreover, without treatment, many individuals continue to experience several relapses because the untreated disorder is not addressed (Cherry, 2007, 39). Atypical antipsychotics are recommended for reducing substance abuse in schizophrenia patients and have been shown to be effective in this manner (Keith, 2007, 259). Studies however do show that those that have developed a strong alliance with their therapist are more likely to comply with a prescribed medication regime (p. 262). Keith to boot adds that, treatment for persons who have both schizophrenia and substance abuse was evaluated by incorporating cognitive-behavioral drug relapse prevention strategies into a skills training method originally developed to teach social and independent living sk ills to patients with schizophrenia.Results demonstrated that participants learn substance-abuse management skills, and that their drug use decreased. Improvements were also noted in medication adherence, psychiatric symptoms and quality of life (p. 263). All in all, recovery is possible for the dual-diagnosed patient, but long term treatment and persistence is required studies have shown that most individuals experience a long line of relapses and several suicidal attempts before fully embracing recovery. Although it is an ugly part of recovery for many of those with schizophrenia, suicidal thoughts and attempts are common. Suicide accounts for approximately10-20% of patient deaths in schizophrenia. In this context, the identification of factors alter to depression in schizophrenia may have implications for the prevention and treatment of these symptoms (Potvin, 2007, 793). Research has shown that this particular population is at an increased risk after being prescribed clozapine or olanzapine and they are currently abusing substances besides an increased awareness needs to be made by those functional with these individuals to identify and screen for the suicidal ideation (Keith, 2007, p. 61). In conclusion, the prevalence of schizophrenia and substance abuse is great in this country as well as the age of onset of symptoms and age of first use. Individual treatment issues as well as recovery issues can act as a barrier to one achieving recovery. Although recovery has been shown to be attainable, suicidal thoughts and attempts can be a major deterrent to many individuals experiencing it through increased compliance via pharmacological services, case management or other methods, individuals can see it.So, schizophrenia or substance abuse which came first, the chicken or the egg? Ill let you decide personally I will work in the framework of integrated treatment and work with the co-occurring disorder. References Cherry, A. L. , Dillon, M. E. , Hellman, C. M. , &Barney, L. D. (2007). The AC-COD Screen fast Detection of People with the Co-Occurring Disorders of Substance Abuse, Mental Illness, Domestic Violence, and Trauma. Journal of three-fold Diagnosis*, No Volume/Issue, 35-53. Academic Search Complete. Ebsco Host.OSU/Lima Campus Lib. , Lima, OH. 10 October 2008 . Hsiao, R. ,& McClellan, J. (2007). Substance Abuse in Early Onset Psychotic Disorders. Journal of soprano Diagnosis*, No Volume/Issue, 87-99. Academic Search Complete. Ebsco Host. OSU/Lima Campus Lib. , Lima, OH. 10 October 2008 . Keith,S. (2007). Dual Diagnosis of Substance Abuse and Schizophrenia Improving Compliance with Pharmacotherapy. clinical Schizophrenia & Related Psychoses, 1(3), 259-269. Academic Search Complete. Ebsco Host. OSU/Lima Campus Lib. , Lima, OH. 10 October 2008 .Kuppin. (2008). ordinary Conceptions of Serious Mental Illness and Substance Abuse, Their Causes and Treatments Findings from the 1996 General Social Survey. American Journal of Public Heal th, 96(10), S120. Academic Search Complete. Ebsco Host. OSU/Lima Campus Lib. , Lima, OH. 10 October 2008 . Potvin. (2007). Meta-analysis of depressive symptoms in dual-diagnosis schizophrenia. Australian and New Zealand Journal of Psychiatry, 41(10), 792-799. Academic Search Complete. Ebsco Host. OSU/Lima Campus Lib. , Lima, OH. 10 October 2008 .