If you have schizophrenia, you may wonder if it’s OK to drink alcohol when taking medications to manage your condition. Doctors say that for most people, that’s not a good idea.

“While many people can have a glass of wine at dinner with no issue, it’s more problematic for those with schizophrenia, as they have a much higher rate of alcohol addiction,” says Srinivas Muvvala, MD, MPH, an associate professor of psychiatry at the Yale School of Medicine in Connecticut. As a result, that one drink often leads to several. When combined with schizophrenia medications, they may make symptoms worse and cause potentially deadly health problems.

Why Drinking Is an Issue

If you have schizophrenia, your doctor may treat it with a type of medication called antipsychotic drugs. These medicines change the balance of chemicals in your brain, helping ease symptoms such as paranoia and seeing or hearing things that aren’t there (hallucinations).

The drugs work well, but they depress your central nervous system and slow brain activity. This can lead to side effects such as dizziness, sleepiness, or trouble thinking or concentrating, says Frank Chen, MD, a psychiatrist and chief medical director at Houston Behavioral Healthcare Hospital. Alcohol is also a central nervous system depressant, so the combination of the two can make these side effects worse.

Drinking alcohol while you’re on antipsychotics can also cause even more serious reactions, including:

All these effects may make it harder for you to have good judgment, Chen notes. “Most of us are able to make good decisions even after a couple drinks, but people with schizophrenia are already at risk for poor decision-making and impulse control,” he says. For example, they may decide to drive, even though they are impaired. Then, they may end up arrested for drunken driving or even have an automobile accident. “Unfortunately, many people with schizophrenia are incarcerated due to exactly these sorts of situations,” he says.

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Alcohol may also make it harder for you to remember to take your antipsychotic medication. About a third of people with schizophrenia have alcohol use disorder, which means they can’t stop or control their drinking. “We know that when people with schizophrenia drink alcohol, they are less likely to follow their medication regimen,” Muvvala says. “As a result, their symptoms worsen. They may have more hallucinations and delusions, and see their cognitive and social skills deteriorate. This may lead them to drink even more. This, in turn, may lead to a vicious cycle that raises the risk of hospitalization, poorer physical health, depression, and even homelessness.”

In addition, alcohol may make it harder for your body to absorb the medication, Chen says. It’s a diuretic, so it can make you pee more. This means the drugs may pass through your system more quickly than they should.

To top it off, the mix of antipsychotic medication and alcohol may damage your liver. “Heavy drinking causes liver disease, and antipsychotic medications can increase the risk of liver problems when combined with alcohol,” Muvvala says. Research shows that about a third of people who take antipsychotic drugs also get liver problems.

What to Do if You Can’t Stop Drinking

It’s best not to drink alcohol at all if you’re on antipsychotic medications. If you find that you can’t stop, it’s important to seek treatment, Muvvala says. “Many patients with schizophrenia who have alcohol use disorder go undiagnosed, because physicians and other medical providers don’t screen for alcohol use adequately,” he says. “It’s important to treat both at the same time, but that’s done in less than 10% of all cases.”

If you think you may have a problem with alcohol, don’t suddenly stop drinking on your own. This can cause alcohol withdrawal symptoms such as agitation, hallucination, or seizures. Your doctor can help you find a substance abuse or addiction center to supervise you during your detox. They may recommend FDA-approved medications like naltrexone, which helps reduce the urge and desire to drink, Muvvala says.

“It’s important to work with psychiatrists with an understanding of both disorders, so you can get the best treatment possible,” he says. This means you’ll be more likely to stick to your treatment plan for schizophrenia.

Sources

SOURCES:

Srinivas Muvvala, MD, MPH, associate professor of psychiatry at the Yale School of Medicine.

Frank Chen, MD, psychiatrist and chief medical director at Houston Behavioral Healthcare Hospital.

Alcohol Research and Health: “Co-Occurring Alcohol Use Disorder and Schizophrenia.”

Shanghai Archives of Psychiatry: “Antipsychotic Drugs and Liver Injury.”

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