Schizophrenia is a chronic mental disorder that affects approximately 1% of the population. It involves disruptions of thought, emotions, and perception, which can lead to paranoia, delusions, and hallucinations, all of which can make social interactions incredibly difficult. SUDs, involving drug or alcohol misuse, affect over 2% of the population. As specified, there is significant overlap between SUDs and schizophrenia, whereby approximately 80% of people diagnosed with schizophrenia will also experience severe substance misuse at some point in their lifetime. This shocking overlap presents unique treatment and ongoing recovery challenges in terms of how patients perceive themselves and others in their community.

Co-occurring schizophrenia and SUDs create what Hune and McGovern describe as “disconnectedness”, meaning profound feelings of isolation with significant difficulties in forming and maintaining meaningful relationships. Although disconnectedness can occur due to varying factors, these researchers focus on the interrelation between the neurobiological and intersubjective understanding of connectedness.

The concept of neurobiological disconnectedness discussed by Hune and McGovern refers to differences in the brain’s ability to connect socially, which is important because the human brain is essentially “wired to connect.” Normally, this reward circuitry allows us to feel pleasure, motivation and desire. In co-occurring schizophrenia and SUDs, however, this region is impaired. Changes in brain activity, for example, can lead to anhedonia, the inability to experience pleasure or joy. In anhedonia, people experience a lack of interest doing things that they like to do. These complications can cause difficulties in identifying desires and life goals, and also involve a low capacity to pursue those goals.

Among those with SUDs, the brain’s reward system is stimulated through drugs or alcohol. While the brain craves temporary drug-induced pleasure, it becomes less able to experience pleasure from anything else. This leads to a cycle of craving and tolerance, where higher doses of substances are needed to achieve the same effect. As a result, experiences of disconnectedness are amplified.

Neurobiological disconnectedness negatively effects both how people feel and their ability to connect with others, whereby social relationships, which typically provide feelings of reward, are less appealing. Consequently, affected individuals become socially withdrawn and increasingly isolated.

Another phenomenon present in co-occurring schizophrenia and SUDs involves feelings of disconnection between individuals and those around them. This type of disconnectedness affects how people relate to each other in terms of sharing their thoughts, feelings, and experiences.

Schizophrenia can distort the sense of self, which can also impact someone’s relationships. For instance, people may struggle to interpret social cues or emotions, leading to confusion or distress during social interactions. As a result, someone may become more withdrawn and less sociable, deepening isolation.

Among those with SUDs, substances may be used as a mechanism to reduce the pain of social rejection or to alleviate emotional pain. Fear of judgement from others may also cause people with SUDs to retreat socially. Cognitive impairments, emotional instability and other social issues related to prolonged drug misuse may also make it harder to connect socially.

One of the most important insights from this research is that effectively treating co-existing schizophrenia and SUDs also requires restoring this sense of connectedness. While traditional treatments, such as psychiatric medications, play an important role in helping to stabilize individuals, and manage symptoms such as hallucinations, they cannot completely restore an individual’s ability to connect socially.

It is important to integrate other therapeutic approaches and peer support specialists to begin to identify and challenge thought patterns, undertake social skills training, practice communication techniques and learn to express thoughts and emotions in a safe and supportive environment. Over time, these skills can help to increase someone’s social confidence, and ultimately reduce their feelings of isolation.

However, a critical, but overlooked factor for ongoing recovery is rediscovering one’s self-identity. For example, both schizophrenia and SUDs distort one’s self-perception, leading to a loss of identity. Since connectedness is also deemed to be “at the heart of [personal identity],” rebuilding a sense of self is crucial, although this can be both difficult and empowering.

This research shines a light on the ways in which mental health professionals can serve a unique role in helping patients to better achieve a sense of connectedness. For instance, although not aligned with analytical schools and other psychotherapy approaches, it may be helpful for professionals to “be with” the patient rather than increasing the power divide between patient and clinician which ultimately increases their feelings of isolation. This is especially important when co-creating professional relationships focused on empathy, connection, and trust building.

Hune and McGovern’s research reveals that recovery from co-occurring schizophrenia and SUDs is about restoring an individual’s ability to connect, both with themselves and with others. This means applying an integrated neurobiological and intersubjective approach to bridge the phenomenon of disconnectedness. Traditional treatments, such as psychiatric medication adherence and standard therapeutic interventions, are likely required. These help to target the cognitive, emotional and social dimensions through a combination of medicine, psychoeducation, skill-building and community support. Intersubjective connectedness calls for a greater focus on re-developing the sense of self, which involves varying aspects of self-awareness, self-identity, and the co-construction of empathy and honesty among healthcare professionals, families, and others in the community. As noted, in addition to helping to restore one’s wellbeing by creating self-awareness in close relationships with oneself and others, developing connectedness is also associated with greater improvement in overall recovery outcomes for both disorders.