My third posting on self-medication-

Comes from the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont.

Now we will turn our attention to how people become habituated to self-medication to obtain brief moments of joy and/or to avoid emotional suffering.  Recall that self-medication becomes a habit (dopamine released in reward centers of the brain) because we learn that certain behavioral responses to suffering provide us with either a short-lived experience of joy or quick avoidance of cues/situations that are associated with painful emotions.  So just how do people do this in various clinical conditions.  Well, addictions to chemical molecules and their effects is most clear: when we feel sad/depressed/lonely, we learn that a stimulant drug will improve our mood soon, and when we feel anxious/fearful we learn that a depressant drug will improve our mood soon.  What we do not yet know is that this learned pattern lays the foundation for a trap, a trap into addictions. Since we did not have wise-mind skills (mindfulness) to better cope with our pain, we used a quick-fix; however, the quick-fix will have to be repeated over and over again for an expanded duration of relief from suffering.  The sadness/depression as well as the anxiety/fear are not improved long-term and, in fact may become more severe.  As we continue to self-medicate, the addiction increases in severity – frequency, dosage, and negative life consequences will increase.

A deeper look into depression shows us that self-medication may take on other forms of behavior beside taking mood-altering drugs.   Some depressed people learn other ways to self-medicate. They may eat more sugars and fats or they may not eat at all in an effort to improve their mood.  They may also isolate – stay in bed or at home –  to avoid situations (people, places, things) that may cause stressful challenges or more depressed affect.  They may capitalize on their fatigue by seeking lots of help and support from others to do things for them.  Although social-emotional support is often very helpful for depressed people, doing too much for them may become a source of learned helplessness, thus learned hopelessness and decreased self-esteem.   If their depression is part of a mixed condition of emotions (bipolar conditions), when in mania they may also buy many things and consume more and more as a means to improve their mood.   There are many ways to self-medicate – and all of them lead to the same place – short-term gain and long-term deterioration.

The experience of severe psychological trauma (PTSD) may offer the best examples of self-medication for anxiety.  In this condition people learn that if they avoid people, places, things that may/have been associated with traumatic cues, they may be able to avoid traumatic symptoms.  So negative reinforcement is at work – avoidance becomes a habit for short-term improvements but long-term deterioration.  In fact many clinicians believe that PTSD cannot be effectively resolved as long as the primary coping behavior is avoidance of cues associated with the traumatic experience.  Another factor complicating PTSD is the co-occurrence of depression and chemical addictions – and sometimes rage reactivity caused by limbic hyper-arrousal and emotion dysregulation.   So once again, the person may revert back to self-medicating their pain.

Another complication in self-medication is cutting and other self-destructive behaviors.  Severe depression may lead to suicidal behaviors, and severe trauma may lead to self-mutilating.  In some cases where trauma has left the person feeling numb, this is also a condition where self-medication may occur.  Some clinicians believe that when a person cuts or self-injures there is a consequential set of internal bodily reactions.  Endogenous opioids may activate, thus causing a change in sensation and emotion.  They person is no longer feeling numb.  The behavior is reinforced to repeat in the future.  There may also be a secondary effect in that people who care about the person may come to their rescue and pay more attention to them.  Perhaps be more kind to them.  Sometimes the attention is desired, and sometimes the attention is undesired.

I hope this slightly expanded posting about self-medication has helped you to see how wide-ranging it can be for people who continue to suffer from physical and emotional pain. Their primary hope for self-empowerment is learning and using evidence-based mindfulness skills in their lives and obtaining effective psychotherapy.  Of course for some, medications may also be necessary.

Anthony R. Quintiliani, Ph.D., LADC

Author of Mindful Happiness

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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

CLICK HERE to Order!