Motivation deficits and use of alcohol and illicit drugs among individuals with schizophrenia

Abstract

This study examined the impact of substance use on intrinsic motivation and evaluated the association between intrinsic motivation and substance use recovery among individuals with schizophrenia. Alcohol and illicit drug use and intrinsic motivation were evaluated at baseline and 6-months for 1434 individuals with schizophrenia from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) using self-rated substance use assessments and a derived motivation measure from the Heinrichs-Carpenter Quality of Life Scale. Results revealed patients had moderate motivation deficits overall and a considerable number were using alcohol or illicit drugs at baseline (n = 576; 40.2%). Regression models at baseline showed patients with low levels of motivation had higher odds of substance use and those who were using substances had greater motivation deficits. At 6-months, substance using patients continued to demonstrate greater motivation deficits; however, those with high levels of motivation exhibited a greater reduction in their use of substances. Findings remained significant after adjusting for clinical confounds and were consistent across any substance, alcohol, and cannabis use. Our results emphasize concerns about substance use compounding motivation deficits in schizophrenia, and suggest that disentangling the motivation-substance use relationship in schizophrenia may facilitate efforts aimed at ameliorating these challenges and improving outcomes.

Precision-medicine findings from the FACE-SZ cohort to develop motivation-enhancing programs in real-world schizophrenia

“…This is an additional argument to distinguish goal-directed motivation from social motivation (Uchino et al 2021). These results add evidence for the complex relationships between alcohol, tobacco and motivation deficits (Bahorik et al 2017;DeAtley et al 2020). While most of the tobacco studies in schizophrenia were focussed on motivation to quit smoking, we found that severe nicotine dependence was strongly associated with goal-orientated motivation deficits in schizophrenia smokers.…”

“…Fifth, addictions have complex relationships with motivation. Tobacco and cannabis smoking and alcohol misuse are frequent in schizophrenia and may have a bilateral relationship with motivation deficits (Bahorik et al 2017;Laksmidewi and Soejitno 2021;Schermitzler et al 2021). Sixth, some antipsychotic treatments induce secondary negative symptoms including motivation deficits (Artaloytia et al 2006;Mas et al 2013;Kirkpatrick 2014;Fervaha et al 2015).…”

Alcohol drinking in male patients with chronic schizophrenia: prevalence and its relationship to clinical symptoms

“…Zhang et al (34) found that, 27.73% of male SCZ inpatients had a history of alcohol consumption in China whereas two other studies reported that 28%-36.5% of SCZ patients with first-episode alcohol use (26,35). Conversely, a longitudinal study of patients with chronic SCZ reported a similar rate of alcohol consumption (34.5%) at baseline (36). A similar finding has been found in German outpatients, showing that male schizophrenia patients tend to consume less alcohol than the general population (37).…”

Unraveling the Association Between Schizophrenia and Substance Use Disorder-Predictors, Mechanisms and Treatment Modifications: A Systematic Review

“…Bahorik et al study indicates that motivation is a strong predictor of recovery and outcome in schizophrenia, substance-abusing schizophrenia patients have lower motivation levels, implying that they are more likely to have poor outcomes and have more difficulty achieving and maintaining treatment goals than those without the disorder. Furthermore, substance-abusing schizophrenia patients are less motivated to improve their substance-related behaviors and are more likely to relapse than non-schizophrenic substance users [ 30 ]. Dual diagnosis patients are less interested in changing their consumption pattern, are more difficult to treat, make slower progress, are more likely to abandon long-term treatment, and are still in danger of return even after years of full remission [ 31 ].…”