The World Health Organization (WHO) says there’s no safe level of alcohol use. For people living with schizophrenia, drinking can be even riskier than you might expect. Schizophrenia already changes how the brain works and makes clear thinking more difficult. Adding alcohol can make things worse — it may intensify symptoms, interfere with medications, and raise the risk of other health problems.

In this article, we’ll cover seven facts about schizophrenia and alcohol use. You’ll learn how alcohol influences brain chemistry and why the risk of alcohol misuse is higher in schizophrenia. Finally, we’ll list steps on how to protect your mental health and improve your prognosis (outlook) with schizophrenia.

1. Alcohol Can Make Schizophrenia Symptoms Worse

If you or a loved one is living with schizophrenia, you’re probably familiar with the common symptoms. For example, hearing voices, feeling paranoid (like someone is out to get you), trouble thinking, or a lack of motivation. These symptoms can be hard to manage and don’t always respond well to first-line treatments, like medication and psychotherapy. With alcohol, they can become even more severe and difficult to control.

Sometimes, alcohol can trigger new episodes of psychosis or make an ongoing episode last longer.

When you drink alcohol, it throws off the balance of brain chemicals called neurotransmitters, especially one called dopamine. Dopamine is closely tied to schizophrenia and psychotic symptoms. Psychotic symptoms are changes in thinking and perception that make it hard to tell what’s real and what isn’t. Too much dopamine can lead to what doctors call positive symptoms. These are extra experiences the brain creates, like hallucinations (seeing or hearing things that aren’t there), delusions (strong beliefs that aren’t based in reality), and paranoia. Alcohol can push dopamine levels even higher, which can make these symptoms stronger and harder to manage.

Alcohol also slows brain activity, which can make the negative and cognitive (thinking) symptoms of schizophrenia worse. These symptoms may include low motivation, difficulty thinking or speaking, or flat emotions. Alcohol can cloud your thinking even more, making it harder to tell what’s real and what isn’t.

In some cases, drinking can trigger new episodes of psychosis or make an ongoing episode last longer. Even small amounts may cause problems if you’re already having many symptoms.

2. People With Schizophrenia Have a Higher Risk of Alcohol Use Disorder

Alcohol use disorder (AUD) is the medical term for alcohol addiction. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), AUD means you have a pattern of drinking that causes problems in daily life, health, or relationships. Symptoms can include:

• Drinking more or for longer than you planned to
• Trying to cut back, but not being able to
• Spending a lot of time drinking or recovering from drinking
• Giving up other activities you enjoy to drink instead
• Drinking even when it causes health problems or other negative consequences

People with schizophrenia are about three times more likely to drink heavily than the general population. In fact, about one-third of people with schizophrenia will be diagnosed with AUD at some point during their lifetime.

People with schizophrenia are about three times more likely to drink heavily than the general population.

Some people living with mental illness may use alcohol as a way to “self-medicate” or to try to ease their psychotic symptoms. Others might have genes that make them more likely to misuse alcohol. In fact, some of the same genetic changes that increase the risk of schizophrenia can also increase the risk of AUD. When someone has both schizophrenia and AUD, it’s called a dual diagnosis or co-occurring disorder.

3. Mixing Alcohol and Antipsychotic Medications Can Be Dangerous

Antipsychotics work by adjusting brain chemicals like dopamine. This adjustment helps reduce hallucinations, delusions, and mood swings. Alcohol can interfere with this process, making the medication less effective.

Your liver processes alcohol and many antipsychotics. Drinking can increase the strain on this organ, raising the risk of liver damage. It can also increase your blood pressure. In some cases, drinking can cause dangerous heart rhythm changes, known as arrhythmias.

Alcohol is a central nervous system depressant — by combining it with antipsychotics, it can lead to extreme sedation (sleepiness), poor coordination, and slower reaction times. This can make falls, accidents, or injuries more likely. Always talk to your healthcare team about whether alcohol is safe for you to drink on your current treatment plan.

4. Alcohol Can Mask, Confuse, or Complicate Mental Health Symptoms

Alcohol changes how your brain processes thoughts and emotions. In people with schizophrenia, this can blur the line between symptoms of the illness and the effects of drinking. For example, alcohol can affect mood, concentration, and memory. All of these symptoms can develop in a person with schizophrenia, too.

This overlap can make it harder for you and your healthcare team to see what’s really happening. Changes in your mental health might be missed or mistaken. Because schizophrenia treatment depends on tracking symptoms closely, hidden or mixed-up signs can delay interventions. This may lead to more intense or frequent psychotic episodes or a longer path back to stability. By avoiding alcohol, you make it easier to notice and treat real changes in your mental health.

5. Stopping Alcohol Suddenly Can Cause Withdrawal

If you drink alcohol often, your body can become dependent on it. Stopping suddenly can cause alcohol withdrawal, which is more than just feeling shaky or anxious. It can be a real medical emergency. Symptoms of alcohol withdrawal may include:

• Sweating
• Nausea
• High blood pressure
• Rapid heartbeat
• Flu-like symptoms

In severe cases, seizures or a dangerous condition called delirium tremens (a sudden state of confusion and agitation) can occur. This life-threatening condition needs immediate medical care.

Alcohol withdrawal can be especially risky for people with schizophrenia. The added stress on the brain can trigger psychotic symptoms to return or become worse. Because of these risks, it’s important to seek medical help before trying to quit on your own. Your healthcare team can offer safe treatment options, such as supervised detox in a hospital or treatment center.

6. Some Treatments Address Both Schizophrenia and Alcohol Use

If you’re living with schizophrenia and AUD, it’s important to have a treatment plan that addresses both conditions. This is known as dual diagnosis treatment, and it targets both mental health symptoms and alcohol misuse together.

A combined treatment plan might use talk therapy and medications that cut alcohol cravings without making psychotic symptoms worse. Outpatient programs, inpatient care, or specialized treatment centers are all good options for treating co-occurring psychiatric and substance use disorders, depending on how severe your conditions are.

Support groups designed for people with dual diagnoses can also help. These give you a safe space to share experiences and learn from others who face similar challenges. When both conditions are treated together, people are more likely to stay in recovery, avoid hospital stays, and prevent schizophrenia from getting worse over time.

7. Talking to a Trusted Healthcare Provider Can Protect Your Mental and Emotional Well-Being

If you still have questions or concerns about alcohol use and schizophrenia, your healthcare team is the best place to start. They can provide more detail about how alcohol may affect your symptoms or medications that you’re taking. They’re also able to review your medications for safety and help you find medical or psychosocial treatment options tailored to your needs and goals.

Your provider can also connect you with mental health services, support groups, and trusted treatment centers in your area, as well as speak with your family or friends to help them support you. Don’t hesitate to ask if you think it would help.

Schizophrenia and AUD are both real medical conditions, just like heart disease or diabetes. They’re not a sign of weakness or something you caused. Don’t let stigma stop you from getting the help you deserve. Asking for support shows strength and is an important step toward recovery.

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