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The Relationship Between Alcoholism and Psychotic Disorders

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The term “psychotic disorders” sometimes has a negative stigma attached to it that is inaccurate. Understanding how alcohol use influences psychotic disorders and the other way around can treat both conditions.

How Is Alcoholism Related to Psychotic Disorders?

Studies show a correlation between alcohol use disorder (AUD) and psychotic disorders, although a correlation does not specifically point to a cause and effect relationship between the two conditions.

Chronic alcohol use leads to malnutrition and changes in your brain over time. Studies show that AUD can lead to:1

  • Brain damage
  • Memory issues
  • Impaired psychological functioning
  • Delays in reasoning and speaking

It is theorized that two different relationships exist between alcohol use and psychotic symptoms:

  1. The alcohol you drink may cause certain psychotic symptoms to appear.
  2. If you experience a psychotic disorder, you may have a genetic predisposition to both conditions or find yourself drinking alcohol to alleviate some of the negative symptoms of your mental health condition.

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Alcohol-Induced Psychosis

Psychosis and psychotic disorders are two different terms that are sometimes incorrectly used interchangeably. The term “psychosis” refers to when you have an episode where your mind breaks with reality.

Some of the symptoms you might experience during psychosis are:2

  • Delusions (i.e., believing things to be true that are not)
  • Hallucinations (i.e., seeing or hearing things that are not there)
  • Incoherent speech
  • Bizarre or inappropriate behaviors for the situation
  • Feelings of paranoia or fear

These symptoms can be frightening and disorienting since you are not able to tell what is real and what is a symptom of your alcohol-induced psychosis at the moment. These symptoms can appear during or shortly after a large intake of alcohol, alcohol withdrawal, or recurring if you have alcohol addiction.3 Researchers are not sure how alcohol causes this reaction in some people.

Alcohol-Induced Psychotic Disorders

Psychotic disorders are slightly different than psychosis. Psychotic disorders are severe mental conditions marked by abnormal thinking and perceptions.4 While psychotic disorders often include the symptoms of psychosis, you can have a psychotic disorder without experiencing psychosis also.

Alcohol-induced psychotic disorder (AIPD) does resemble another psychotic disorder, schizophrenia, in that it is often accompanied by hallucinations and paranoia. Studies find that with AIPD: 1

  • Recurring episodes of psychosis typically start within a month of alcohol intoxication
  • Lasts about a month to six months
  • Stops recurring in less than two years on average

The exact cause of alcohol-related psychotic events is unknown, but researchers believe it is likely related to the function of chemicals in your brain, including dopamine and serotonin.3

Psychotic Disorders Leading to Alcohol Use

There is a lot of research understanding the relationship between schizophrenia and alcohol use. If you have schizophrenia or schizoaffective disorder, you are three times more likely to drink heavily than the general population.5

The reasons for these two conditions co-occurring are just hypotheses. Some researchers believe that genetics leading to dysfunctions in the reward system of the brain occur in both groups. Others speculate that alcohol use becomes a coping mechanism for alleviating negative symptoms like depression and anxiety associated with psychotic disorders.

What Are Psychotic Disorders?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), defines a psychotic disorder as a deviation from the norm in at least one of the following areas:6

  • Delusions
  • Hallucinations
  • Disorganized thinking and speech
  • Disorganized or abnormal motor behavior, including catatonia
  • Negative symptoms

While the signs of a psychotic disorder can feel scary to experience or witness, you do not need to be afraid of someone with a psychotic disorder. You are not dangerous if you have one of these conditions, and there is treatment available to help you.

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The following psychotic disorders are described in the DSM-5.6


The most common psychotic disorder is schizophrenia. This disorder is marked by delusions, hallucinations, and changes in behavior that last longer than six months. As symptoms persist, you will notice a decline in social functioning, school, and work.

Schizoaffective Disorder

Schizoaffective disorder is when you have both the symptoms of schizophrenia along with a mood disorder like depression or bipolar disorder.

Schizophreniform Disorder

The symptoms of schizophreniform disorder are the same as schizophrenia, but they only last for one to six months.

Substance-induced Psychotic Disorder

Substance-induced psychotic disorder refers to the condition where the use of a substance, like alcohol, causes hallucinations, delusions, or confused speech and behavior.

Brief Psychotic Disorder

This disorder describes a brief, sudden onset of psychotic symptoms, usually in response to a stressful event. The duration of this disorder is usually less than a month.

Delusional Disorder

The main symptom of delusional disorder is experiencing false beliefs that last for at least a month. False beliefs are based on something that could be true, like having a disease, but are not true.

Disorder Due to Medical Condition

Sometimes certain illnesses like a head injury or brain tumor may cause psychotic symptoms like hallucinations or delusions.

Who Is at Risk for Alcoholism and Psychotic Disorders?

Psychotic disorders like schizophrenia are highly hereditary. Alcohol use disorder has also been linked to hereditary factors, so if you have a family history of either condition, you are at a greater risk of developing one or both disorders.1

Alcohol-induced psychotic disorders are diagnosed more often in the following groups:1

  • Caucasian men
  • Lower socio-economic individuals
  • Those with a history of mental health problems or alcohol-related difficulties on their father’s side
  • Becoming dependent on alcohol at an early age
  • Experiencing numerous hospitalizations

What Does Dual Diagnosis Treatment Look Like?

Managing a psychotic disorder and recovering from alcohol use disorder can feel like a daunting task, but treatment does exist for both of these conditions. The most effective treatment plan includes interventions to treat both issues simultaneously.

Without proper treatment, you could suffer from long-term risks such as:7

  • Worsening symptoms of either disorder
  • A heightened risk of being the target of interpersonal violence
  • Experiencing depression
  • Engaging in self-harm
  • Becoming suicidal

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One of the first and most important parts of your treatment plan will include medication. There are medicines, approved by the Food and Drug Administration (FDA), that can treat alcohol addiction by reducing cravings and alleviating withdrawal symptoms as you stop consuming alcohol. 7

Let your doctor know about co-occurring psychotic disorders so they can advise you on how certain medications will interact with your other conditions.

You will also likely be prescribed antipsychotic medications. Stabilizing your symptoms can help to improve social and community interactions while you are also in recovery for alcohol use disorder. Some medications, like clozapine (Versacloz), have been shown to reduce symptoms of AUD and schizophrenia.7

Having an integrated approach to treating both conditions simultaneously ensures that your medications will interact well together.


Once you are medically stable after any alcohol withdrawals and have a proper medication plan in place, the next stage of treatment is in improving psychological and emotional well-being.

This stage includes regular therapy with a mental health professional to help you identify negative thought patterns and how to change your ways of thinking and behaving.

Therapeutic care may look different for someone with a psychotic disorder than for other mental health conditions. While group therapy can be a useful tool for some, if your symptoms include paranoia or social withdrawal, group settings could make you uncomfortable.7 Having a treatment team that understands your conditions will give you the best chance at success in recovery.

If you or someone you love has alcohol addiction or a psychotic disorder, please call 800-948-8417 Question iconCalls are forwarded to these paid advertisers to speak to a specialist about treatment options.


  1. Hendricks, M.L., Emsley, R.A., Nel, D.G., Thornton, H.B. & Jordaan, G.P. (2017, April 26). Cognitive changes in alcohol-induced psychotic disorder. BMC Research Notes, 10 (166).
  2. National Institute of Mental Health. What is Psychosis?.
  3. Stankewicz H.A., Richards J.R., and Salen P. (2021, July 19). Alcohol Related Psychosis. StatPearls Publishing.
  4. National Library of Medicine. (2021, August 10). Psychotic Disorders. MedlinePlus.
  5. Archibald, L., Brunette, M. F., Wallin, D. J., & Green, A. I. (2019). Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol research: Current Reviews, 40(1).
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  7. National Institute on Alcohol Abuse and Alcoholism. (2002). Comorbidity of Alcoholism and Psychiatric Disorders. National Institutes of Health, United States Department of Health and Human Services.
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