Are You Self-Medicating?

Substance abuse and mental illness often go hand in hand. According to the 2014 National Survey on Drug Use and Health: Mental Health Findings report, of the 20.2 million adults in the U.S. with a substance use disorder, over half of them – 50.5% – also had some sort of co-occurring mental illness – mainly depression and anxiety disorders.

Among the substance abusers, the prevalence of bi-polar depression was 5–6 times more likely than in the general population.

Why the High Rates of Co-occurrence?

In 1985, the American Journal of Psychiatry introduced a hypothesis to explain why substance abuse and mental health issues so often occur together.

Called the “self-medication hypothesis,” it states that alcohol and drug abuse is often used as a way to cope with the distressing symptoms of mental health issues. The hypothesis suggests that the drugs of choice for self-medicating individuals are not random, but are chosen specifically because they best medicate a particular condition and provide the most emotional relief.

Dr. Ed Khantzian, author of Treating Addiction as a Human Process (Rowman & Littlefield Pub.,1999, 2007) suggested that an individual’s drug of choice was determined through experimentation, and when a drug was found that provided the best mix of desired drug effect (relaxation, stimulation, etc.), relief from the individual’s inner psychological turmoil, and also suited the individual’s underlying personality traits (usually taken alone vs. in social situations etc.), then this would become the person’s drug of choice.

David Duncan, Ph.D., research consultant and Clinical Associate Professor in the Department of Community Health at Brown University School of Medicine, theorized that drug dependence is an avoidance behavior, providing a temporary escape from a problem, and that taking the drug is reinforced by both positive and negative behavior reinforcement. Positive reinforcement is provided by the “high feeling” and by acceptance/approval from peers; negative reinforcement involves a desire to avoid the discomfort of withdrawal symptoms.

Common Problems of Self-medicating for Emotional Relief

When both substance abuse and mental health disorders occur together, the resulting problems are also multiplied. Common issues among people using substances to self-medicate symptoms of a mental health issue include:

• Worsening of symptoms: a person with both addiction and another mental disorder has a greater risk of each disorder worsening over time.
• Overlapping triggers. Stress, trauma and poor social support are triggers for both substance use and mental/emotional distress.
• Impaired brain responses: Substance use increases sensitivity of neurons in the brain’s reward center, which may contribute to the typical progression from occasional to increasingly frequent and intense use of substances. Mood disorders often follow a similar course of increasingly distressing symptomatic episodes separated by progressively shorter periods of remission.
• Resistance to treatment: When substance use and mental health issues are present together, each impacts the treatment of the other, and this often makes both more resistant. Treating each separately is not as effective as combining treatment for both into one integrated program of care.

Common Self-Medicating Practices

Typical drugs and their self-medication uses are:

• Alcohol, Tobacco, Cannabis (Depressants)

In low doses, depressants like alcohol, tobacco and cannabis can temporarily lessen symptoms of depression or anxiety. But prolonged use or higher doses of alcohol can lead to alcoholism and physical health issues, such as liver damage. Alcohol use can also cause other latent mental illnesses to surface.

Alcohol is also often used to relieve the symptoms of the manic cycles of bi-polar disorder, because it provides a feeling of sedation and relaxation. But its effects are short-lasting and people who have a bipolar disorder complicated by a substance use disorder are more likely to experience mixed episodes of depression and mania, as well as rapid cycling between the two.

Because it can reduce inhibitions and soften rigid defenses, depressants – particularly alcohol – are sometimes used by people with social anxiety disorder to overcome excessive social inhibitions.

Cannabis, in small doses, increases the brain chemical serotonin and relieves symptoms of depression. But in high doses, it has the opposite effect and causes depression to increase.

• Cocaine, Amphetamines, Caffeine (Psycho-stimulants)

Cocaine, amphetamines and caffeine produce temporary improvements in physical and mental functioning, including increased energy and feelings of euphoria. Stimulants tend to be used by individuals who experience depression, to lift mood and increase self-esteem. However, cocaine use can be fatal. Cocaine affects the body’s cardiovascular system; cocaine-related deaths are usually related to sudden heart failure. Amphetamines (ex: meth, ADD/ADHD drugs) speed up the function of the heart and carry the risk of a stroke.

Some people self-medicate with cocaine to counteract depression, but the “come-down” feeling after the drug has worn off makes it a poor choice of treatment for depression. Many cocaine users find that it worsens their symptoms of depression overall.

• Opiates (Heroin, Morphine, Oxycontin)

Opiates, such as heroin, morphine and Oxycontin, function as analgesics and lessen the sensation of pain, while also increasing pain tolerance. Opiates produce a sensation of euphoria and have been reported to be used as self-medication for aggression and rage. Tolerance to opiates can develop following its use for pain relief, and addiction may result. Use of higher doses to counteract tolerance can lead to death from cardiac or respiratory arrest.

Treatment Options for Self-Medication

The best way to treat a self-medicating problem that is associated with a mental health issue is to use a therapy strategy that treats both conditions at the same time. Learning strategies to self-regulate mood symptoms helps dispel the belief that a workable option for dealing with intolerable feelings is to use addictive agents.

Cognitive-behavioral therapy (changing irrational beliefs, challenging negative assumptions, controlling automatic thoughts) is useful in treating co-occurring mental health and substance abuse conditions. Certain medications are used to treat opioid, alcohol, and nicotine addiction and may also alleviate symptoms of other mental disorders. Wellbutrin is a drug approved for treating depression and nicotine dependence, and it may also reduce cravings for methamphetamine. However, this treatment is new and it has not been extensively studied.

If you are experiencing a co-occurring mental health disorder with addiction, it is advisable to seek the assistance of a qualified a mental health professional who can help you deal with both at the same time and give you a better chance at obtaining long-term recovery,