Schizophrenia and substance abuse: Is schizophrenia forgotten?

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Abstract

DOI:10.1097/YCO.0000000000000328 In the United States, much political and community attention has been drawn to the so-called ‘Opioid epidemic’. Many young people are dying from overdoses of self-injected opioids. These deaths have received widespread attention and mandates to stop their occurrences. Indeed, the global burden attributable to substance abuse is highest of all mental illnesses [1]. It is clear that preventive measures, including emergency opiate antagonist kits and medication-assisted therapies, need to be instituted and thus the political machinery has been set into motion to fight this illness and what has now been labeled an epidemic of huge proportions. Those psychiatrists who get specific training in substance abuse and take on the task of providing of medication-assisted therapies for substance abuse in their practices are in great demand and are now in the mainstream of psychiatry in the United States. A decade ago, speakers at meetings would comment thathalf the psychiatric hospital beds were taken up by people with schizophrenia and so combating schizophrenia became a prioritized economic and political issue. But the conversation has since changed to the number of hospitalizations for drug and alcohol withdrawal. When commenting to a colleague on the observation that schizophrenia seems ‘forgotten’, the response was ‘Young people are dying of opiate addiction, but they do not die of schizophrenia’... But is this true? In one recent study, it was shown that the suicide rate in people with schizophrenia is almost as high as that of patients with affective disorder and many folds higher than in the general population [2]. It is widely known that peoplewith schizophrenia die at an earlier age than that of the general population and suicide, as well as many other factors, contribute to this prematuredemise [3].Despite theneedtoprovide integrative treatment, for which convincing evidence does exist, for schizophrenia patients, the availability for treatment still leaves much to be desired [4]. Another drug of abuse, cannabis, also has gotten considerable public attention, not as something to fight against, but something to fight for. In the United States, and many countries abroad, it is slowly becoming legalized and used medically for pain, seizures, tics, and some psychiatric disorders,