Are you self-medicating to cope with symptoms of mental illness or trauma?

Why do people abuse drugs and alcohol? Why do some people become addicted to drugs and alcohol?

People turn to drugs and alcohol for many reasons. For some, it may be simple curiosity, a desire to fit in with peers or satisfy a need for increased stimulation. Others use drugs to escape reality, alleviate stress, cope with trauma, self-manage physical pain, or to try and mask the symptoms of mental illness. Self-medicating describes the situation where a person uses drugs to cope with or mask the symptoms of mental illness. This is why treating the root cause of addiction is so crucial. A holistic approach to addiction treatment to address underlying trauma and any co-occurring mental health issues greatly increases the likelihood of achieving long term sobriety and health.  

 

Mental Health

Individuals with certain mental health disorders are significantly more likely to develop an addiction to drugs or alcohol than people not suffering from these disorders. People with a dual diagnosis experience a more difficult path to recovery; however treatment programs like our program that are flexible, client-centered, educate patients about the effects of substance use on mental health, focus on long term management and reduce barriers to treatment increase the likelihood of treatment success.1 All of our clients undergo a thorough psychiatric assessment as part of our program and are treated with a customized program to their needs.

 

ADHD

ADHD is associated with trouble paying attention and sitting still, as well as an inability to tolerate boredom and tedious tasks. ADHD and substance use disorder are both disorders of disinhibition, meaning people with these disorders are more likely to engage in risky behavior.2 Individuals with ADHD are more than twice as likely to develop cannabis or cocaine abuse or dependence. ADHD can have a negative impact on work and school performance, and people with this disorder may turn to drugs and alcohol to manage symptoms. Additionally, individuals with ADHD have lower levels of dopamine in their brain (a neurotransmitter associated with feelings of pleasure and reward as well as memory, attention and learning) and may turn to drugs and alcohol which increase dopamine release to combat this deficiency.3,4

 

Anxiety

A generalized anxiety disorder is characterized by persistent and excessive worry about various aspects of life such as work or school that the individual finds difficult to manage. Physical symptoms are also present with anxiety including trouble sleeping, trouble concentrating, becoming easily exhausted and feeling irritable.1 Living in a constant state of fear and worry can take a toll on one’s professional and personal life, and individuals with anxiety may turn to drugs or alcohol to numb their symptoms. Anxiety disorders commonly coexist with substance use disorders and some studies indicate that early treatment of anxiety may actually prevent substance abuse.5 

 

Depression

Depression is associated with feelings of sadness, emptiness and hopelessness as well as a loss of interest in activities that were once pleasurable. Depression is also characterized by a loss of energy, trouble sleeping, an inability to concentrate, one’s mind may feel foggy.1 Everyone experiences highs and lows in their mood, but for individuals with depression, the low periods don’t go away. It can interfere with one’s ability to work, socialize and function. Depression and addiction often co-occur, and individuals may turn to drugs or alcohol to manage the symptoms of their illness, but over time substance abuse will intensify the symptoms of depression, leading to a vicious cycle. 

 

PTSD

Trauma, PTSD and addiction often go hand in hand. After exposure to trauma, people who develop PTSD may experience flashbacks, nightmares and symptoms of anxiety and depression, which impact on their ability to function. Substances like alcohol release endorphins-hormones which activate the body’s opiate receptors and make one feel good. Immediately following a traumatic event, the body will naturally release a flood of endorphins to help combat the emotional and physical pain of the trauma. Endorphin levels gradually decrease which can lead to withdrawal and contribute to emotional distress; individuals may then turn to a substance such as alcohol to compensate for this endorphin withdrawal and mask the symptoms of PTSD.6

 

Schizophrenia

Epidemiologic studies show a high degree of overlap between schizophrenia and addictive disorders. Up to 50% of patients with schizophrenia have a drug or alcohol dependence.7 Cannabis use in particular among individuals with schizophrenia is associated with a more difficult course of illness.8 There are many theories for the high prevalence of substance use among individuals with schizophrenia, but the self-medication explanation is most common. Alcohol or drugs are used to cope with social withdrawal, apathy, a general sense of unease and sleeping disturbances, but substance abuse creates a harmful cycle where the symptoms of schizophrenia are exacerbated.  For instance, auditory hallucinations and paranoid delusions occur more often among those abusing alcohol.8 

 

Personality Disorders

Personality Disorders describe a wide range of disorders that have in common difficulty managing stress and relationships. These can lead to significant distress, difficulty coping and substance abuse to manage intolerable emotions.2 A 2017 study in the journal of European Psychiatry suggested that anywhere from 65% to 90% of patients treated for substance abuse have at least one personality disorder.9  

  1. Carla A. Green, Micah T. Yarborough, Michael R. Polen, Shannon L. Janoff & Bobbi Jo H. Yarborough (2015) Dual Recovery Among People With Serious Mental Illnesses and Substance Problems: A Qualitative Analysis, Journal of Dual Diagnosis, 11:1, 33-41, DOI: 10.1080/15504263.2014.975004 
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). http://doi.org/10.1176/appi.books.9780890425596
  3. Wise, R. A. (1996). Addictive drugs and brain stimulation reward. Neuroscience, 19, 319-340
  4. Volkow, N. D., & Morales, M. (2015). The brain on drugs: From reward to addiction. Cell, 162, 712-725.
  5. Deas-Nesmith, D., Brady, K.T. & Campbell, S. Comorbid Substance Use and Anxiety Disorders in Adolescents. Journal of Psychopathology and Behavioral Assessment 20, 139–148 (1998). https://doi.org/10.1023/A:1023074213806
  6. Volpicelli J, Balaraman G, Hahn J, Wallace H, Bux D. The role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Research & Health : the Journal of the National Institute on Alcohol Abuse and Alcoholism. 1999 ;23(4):256-262.
  7. Brady K. , Sinha R. Co-occuring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. 2005;162:1483–1493. 
  8. Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in clinical neuroscience, 8(1), 37–43. 
  9. S. Goretti, M.D.C. Sanchéz Sanchéz, P. Lucas Borja, G. Bautista Rivera, M. Rodríguez Lara. The relationship between personality disorders and substance abuse disorders, European Psychiatry, Volume 41, Supplement, 2017,Pages S473-S474,

 

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