In the United States, around 1 out of every 10 people who are at least 12 years old abused an illicit drug in the month leading up to the 2014 National Survey on Drug Use and Health (NSDUH).
These statistics show that 27 million American adults were considered to be current illicit drug users while nearly 140 million were alcohol consumers. In 2013, the NSDUH estimated that close to 3 million American adults tried an illicit drug for the first time that year, which is almost 8,000 people initiating drug abuse each day on average.
There are many reasons that people turn to drugs or alcohol, from social pressures, to a desire to feel a certain way, to curiosity. People may also use alcohol or drugs because of a desire to escape reality, relieve stress, forget a trauma, ease physical or emotional discomfort, manage side effects of other drugs or medications, or try and reduce symptoms of a mental illness. The term self-medicating is used when substances, drugs or alcohol, are abused to mask symptoms of a mental health issue.
Different types of psychoactive substances may be used for various reasons when self-medicating. Examples include:
Both prescription and illicit drugs may be abused for the purposes of self-medication, and anyone who suffers any form of physical or emotional discomfort may do so.
When a person feels stressed, certain changes to the chemistry in the brain and functions of the central nervous system are made. For instance, adrenaline and the neurotransmitter norepinephrine, which is involved in memory functions, may spike causing the “fight-or-flight” reaction, and body temperature rises, blood pressure quickens, heart rate accelerates, and breathing gets faster. Individuals may feel irritable, jumpy, restless, anxious, and on edge.
Stress, according to the National Institute on Drug Abuse (NIDA), is a significant contributing factor in why people abuse alcohol or drugs in the first place and also why they may continue to do so. Chronic stress can cause someone to want to turn to mind-altering substances for relief. Childhood trauma, such as neglect, abuse, or other major stressors experienced before the brain is fully developed, can increase the odds for someone developing an issue with substance abuse later in life, NIDA further expounds, as it may actually damage regions of the brain used for controlling impulses and making good decisions. In a study of adolescents who were being treated for issues surrounding substance abuse, almost three-fourths reported a childhood trauma, the National Child Traumatic Stress Network (NCTSN) reports.
The onset of post-traumatic stress disorder (PTSD) after being the victim of, or witnessing, a near-death experience is also closely tied to substance abuse, as individuals battling PTSD may wish to escape reality and try to forget the event by self-medication methods. Military soldiers and veterans, due to the nature of combat, may be at a high risk for both PTSD and a substance use disorder (SUD), as the U.S. Department of Veterans Affairs (VA) estimates that one out of every three veterans who look for help for an SUD also suffer from PTSD. Alcohol may be a common substance used for self-medication purposes of PTSD. In a study published by Psychiatric Times, more than half of the military personnel surveyed who were deployed and had exposure to combat binge drank alcohol.
Military members are not the only people to experience PTSD and extreme stress, however, as anyone with exposure to a traumatic event may be at risk. The homeless population, for example, may be at a high risk for self-medication, perhaps because of high stress and attempts to cope with living on the street, or due to an untreated medical or mental illness. The incidence of substance abuse is much higher in the homeless population than in the general population, the National Coalition for the Homeless reports. No one is immune to stress, and many times drugs and alcohol are used to attempt to dull its effects.
In addition to PTSD, mood and anxiety disorders also commonly co-occur with substance abuse. The Anxiety and Depression Association of America (ADAA) reports that around 20 percent of individuals suffering from an anxiety or mood disorder also battle a substance use disorder, and vice versa. Depression and anxiety may be the result of many different factors, including an imbalance in brain chemistry, biological and genetic contributors, high stress, trauma, and environmental factors.
Anxiety disorders, depression, and PTSD are often the result of certain parts of the brain, like the amygdala and the prefrontal cortex, being overactive, Psychology Today reports. Therefore, substances that depress the central nervous system like benzodiazepines (which consequently are often prescribed to treat anxiety) and alcohol may actually calm these nerve firings and therefore temporarily dispel some of the difficult psychological symptoms, likely making these substances a popular form of self-medication for these disorders.
Both anxiety and depression are also often side effects of drug withdrawal as well, when a person abuses a substance regularly and becomes dependent on it.
Substance abuse may then lead to heightened anxiety and depressive symptoms, especially in individuals who battle addiction to drugs or alcohol. It may be hard to ascertain which came first, the substance abuse or the mental illness. Drugs and alcohol may provide temporary mood enhancement and reduction in anxiety levels that individuals suffering from mood or anxiety disorders, or drug withdrawal symptoms, may crave, thus perpetuating a pattern of abuse to try and keep these side effects at bay.
About half of all individuals who suffer from a serious mental illness in their lifetime will also struggle with substance abuse, and the reverse may also be true for individuals who abuse drugs (and for one-third of those who abuse alcohol as well), the National Alliance on Mental Illness (NAMI) postulates. The stress brought on by mental health issues may lead individuals to try and self-medicate side effects of untreated mental illness. The journal Health Services Research published that individuals suffering from mental illness were more prone to abuse illicit drugs, especially marijuana, than the general populations, and the rates of drug abuse increased with the severity of the mental health problems. About 18 percent of Americans battled some kind of mental illness in 2014, and around half of the time, the mental illness was considered serious, per the NSDUH. A serious mental illness (SMI) can interfere with a person’s daily life and make it difficult to function normally within the parameters of society. Untreated mental illness may cause a person to look to drugs or alcohol for symptom relief.
Common ailments and conditions that co-occur with substance abuse are:
When someone uses drugs or alcohol, a number of changes occur within the brain.
Generally, some of the neurotransmitters that enhance pleasure are increased; many of the regions of the brain involved in the stress response are tempered; and individuals may be temporarily removed from reality. This can be a highly desired effect for someone suffering from high levels of stress or from a mental health disorder or medical issue.
Over time, however, repeated drug abuse may alter the brain chemistry involved with emotional regulation, motivation, pleasure, and reward-processing as substance dependence sets in. Once a dependency has formed, the brain may not continue to function as it did previously, and a chemical imbalance is experienced when these substances wear off or are removed. This can lead to worsened mental illness symptoms and increased stress levels. Withdrawal from many substances requires a specialized medical detox program in order to ensure that withdrawal symptoms are properly and safely managed. Medications are often used during medical detox to help with this.
Taking drugs or drinking alcohol can interfere with treatments and prescribed medications for mental or medical ailments as well. The potential side effects of the abused substances as well as the symptoms of any co-occurring disorder may be exacerbated. SAMHSA reports that close to 8 million American adults suffered from co-occurring mental and substance abuse disorders in 2014. Co-occurring disorders means that a person struggles with more than one disorder at the same time, and often, the optimal way to treat the disorders is through an integrated model that can manage symptoms of both simultaneously. Co-occurring disorders are often complexly intertwined together; by treating both at the same time, both disorders can be improved.
Self-medication is often the result of an underlying issue, be it a medical problem, a mental health concern, stress, or other environmental contributor.
Integrated treatment often uses medications to stabilize a person and therapeutic methods to help the person understand potential triggers and methods for managing them in the future. Behavioral therapies teach new life skills, stress management techniques, and communication skills. They also help individuals gain personal insight, thus enhancing self-confidence and self-reliance. By understanding the reasons behind self-medication and learning new and healthier ways to manage these stressors within a comprehensive treatment program, overall quality of life can be improved and recovery sustained.