Are You Self-Medicating?
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:
- Stimulant drugs like cocaine, methamphetamine, attention-deficit hyperactivity disorder, or ADHD, medications (Adderall, Ritalin, Vyvanse): to increase focus, attention, and energy levels, as well as for combating depression and increasing pleasure
- Central nervous system depressants like alcohol, benzodiazepines (Valium, Ativan, Klonopin, Xanax), and prescription sleep aids (Ambien, Lunesta, Sonata): to elevate mood, escape reality, increase sociability, help a person sleep, and decrease anxiety
- Opioid drugs like heroin and prescription pain relievers (OxyContin, Vicodin, fentanyl, morphine): to relieve pain, depression, and anxiety, and to enhance relaxation
- Marijuana: to elevate mood, enhance relaxation, and create a break from reality
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.
The Relationship between Trauma, Environmental Stressors, and Substance AbuseSomething that encourages a person to turn to drugs or alcohol for respite is called a trigger or stressor, and these are different for different people. A triggering event may be something big, like losing a job, getting a divorce, the death of a loved one, being involved in accident, or being the victim of a crime, or it may be smaller like a bad grade on a test, a fight with a loved one, or anything that may increase stress, anxiety, or cause a depressed mood. Drugs or alcohol may seem to be a beacon in times of stress and may actually provide temporary relief and respite from reality. Of course, this is short-lived, and self-medication will serve to make matters worse in the long-run, increasing health problems, damaging relationships, and providing a poor coping mechanism that cannot be safely sustained on a long-term basis.
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.
Substance Abuse to Ease Depression and Anxiety Symptoms
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.
Substance Abuse and Other Medical or Mental Health Disorders
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:
- Chronic pain: Pain can come from a variety of sources. When it isn’t properly managed, it can impair quality of life and may lead individuals to seek out alcohol or drugs for relief. Opioid drugs are prescribed as painkillers but have a high incidence of abuse and addiction and may be used past their medical scope. People who suffer from chronic pain may use these drugs, or other psychoactive substances, to self-medicate physical and resulting psychological ailments at high rates, the journal Current Pain Perspectives reports.
- Sleep disorders: About 50-70 million adults in the United States suffer from issues sleeping via a wakefulness or sleep disorder, the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institute of Health (NIH) reports. Lack of sleep can create a multitude of physical and emotional issues that individuals may attempt to self-medicate with drugs or alcohol. Sedatives and tranquilizers (like benzodiazepines and “z-drugs”) are generally prescribed for the short-term relief of insomnia. These drugs are commonly abused, however, and may be used beyond their prescribed intent for continued relief, or to produce a euphoric effect, even though doing so can lead to drug dependence, and actually compound and exacerbate sleep issues. Drugs and alcohol can interfere with regular sleep patterns and decrease quality of sleep. A study published in the journal Psychiatry found that people suffering from sleep disorders abused alcohol and narcotic drugs most commonly, with about half doing so in order to enhance sleep. Depressant drugs may be abused to help someone sleep at night and stimulants may be abused to stay awake during the day.
- ADHD: One of the primary symptoms of this disorder is an inability to control impulses. While it is often diagnosed in childhood, adults also suffer from this disorder and may often go undiagnosed, prompting them to take matters into their own hands. Alcohol and marijuana are the most commonly abused substances by adults suffering from ADHD, and more than 15 percent of individuals diagnosed with the disorder were surveyed to have a problem with, or dependency on, drugs or alcohol, ADDitude magazine reports.
- Schizophrenia: A serious mental illness wherein individuals experience psychosis, those suffering from schizophrenia symptoms may regularly attempt to quell them with drugs or alcohol. The most popular substance of abuse for this population is nicotine, as individuals battling schizophrenia smoke cigarettes at rates three times that of the general population, Psych Central reports. Nicotine may reduce some of the negative symptoms of the disorder and improve focus and cognition, at least temporarily, although it may also interfere with antipsychotic medications prescribed to treat schizophrenia. Alcohol and cannabis (marijuana) are also abused at much higher rates, about three times higher, by those suffering from this disorder than those in the general public, the American Journal of Psychiatry publishes.
- Bipolar disorder: This disorder is a SMI characterized by significant mood swings and periods of extreme mania and psychosis and/or severe depression. The journal BMC Psychiatry reports that individuals battling bipolar disorder also suffer from an SUD at rates between 35 and 60 percent. The extreme moods swings associated with the disorder may be regularly self-medicated with alcohol and also with marijuana, cocaine, sedatives, or opioids in that order, NIDA publishes.
- Impulse control disorders: Often considered “behavioral addictions,” impulse control disorders include kleptomania, pyromania, and intermittent explosive disorder, all of which are characterized by an inability to control impulses that are harmful to themselves and others. Substance abuse disorders often co-occur with these disorders, according to the journal Biochemical Pharmacology, as not only is willpower impaired in this population but also cravings may be temporarily soothed by drugs or alcohol.
- Personality disorders: This category includes disorders like borderline personality disorder (BPD), antisocial personality disorder, narcissistic personality disorder, and paranoid personality disorder. Generally speaking, symptoms include inflexible behavioral patterns that are not socially acceptable, resistance to change, and lack of awareness surrounding the problematic nature of the behavioral issues. Self-harming behaviors, an inability to fit in socially, depression, anxiety, and explosive anger may also be symptoms of these disorders, which people may attempt to self-medicate with alcohol or drug abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that individuals who have had a diagnosis of BPD at some point in their lives also battle an SUD about half of the time.
Getting Help for Self-Medication
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.