Inner Workings of Self-Medication Process
To continue our discussion about the self-medication process we will first turn to the human brain. The human brain is the most complex system known to science. Here, my comments will be basic. Self-medication often has roots in the quality of our earliest childhood experiences (attachment and object relations with significant care-takers). Insecure attachment sometimes leads to low frustration tolerance and internal self-discomfort as well as interpersonal insecurities. Such vulnerabilities cannot well serve a person facing serious emotional challenges, especially if such challenges occur early in life. Attachment style and personality variables may play significant roles in the realities of mind, brain, body and heart.
The frontal/prefrontal brain areas deal mainly with executive functions; the limbic area deals mainly with survival needs and emotional reactivity as well as memory of such experiences; and, the reward centers release dopamine in the process of consciously rewarding experiences (habits) – like changing mood for the better via drug use. Positive reinforcement occurs when consequences of behavior are desired (feeling “high”); negative reinforcement occurs when behavior leads to avoiding expected negative experiences ( depression, anxiety or reactivity especially when trauma is involved). In these situations, unhelpful habits are born and eventually may dominate. When we are conscious of the relationship between stimulus, behavior and consequence it is operant/instrumental conditioning. When are not conscious of the relationships (stimulus, behavior, consequence and environmental cues) it is classical conditioning. Both forms of conditioning exist in the formation of both unhelpful habits and helpful habits.
Let’s focus on chemical addictions as a example. Humans want to be happy and do not like to suffer any form of physical or psychological pain. We also dislike boredom. According to the mindfulness traditions, life gives us three core options: happiness, suffering, and boredom. Our emotional responses to whatever life brings to us is an inside job. When people suffer – especially when they do not have wise-mind skills for living – they want immediate relief. We humans do strange things to control this desired clinging to joy and avoiding pain. In fact even when we escape/avoid pain, it feels like a form of joy. Suppose a person feels very sad/depressed; it will not take long for that person to discover that taking stimulant drugs results in almost immediate short-term relief (an improved mood). Suppose a person is very anxious (stressed or fearful); likewise, it will not take long to discover that taking a depressant/sedative drug reduces the anxiety. In both cases the person likes the consequence of their behavior; however, the improved mood does NOT last. Effects are short-lived, about the half-life of the drug being ingested. This form of self-medicating is reliable for a while until biological and/or psychological tolerance sets in. Consequently, dosage and frequency of self-medicating behaviors increase as the person becomes reinforced by their drug-taking behavior. The self-medicating habit takes on a life of its own – as a strong habit to reduce emotional suffering. Often recovery from drug use problems begins with small, more helpful, competing habits. In fact, early recovery may be defined as the use of newer helpful habits to weaken older self-medicating habits.
Use the helpful habits more and the unhelpful habits less, and we are on the way to recovery process. It is all about motivating a person to dare to place a helpful behavior (mindfulness habits for example) against an unhelpful behavior – a self-medicating behavior that has produced some short-term relief from suffering. In self-medication the negative state we are trying to escape from does not improve long-term, and the new behavior (drug-taking) may result in a new problem – addictions. Recovery takes time, safety, and authentic caring in a therapeutic or helping relationship with psychotherapists, body-workers or peers in recovery. Become aware of self-medication – fight it with helpful habits that produce lasting improvements.
Anthony R. Quintiliani, Ph.D., LADC
Author of Mindful Happiness
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