What do we mean by “self-medication”?  The term gets thrown around a lot but I think it’s actually pretty apt. People use all types of drug to modify their moods. For people with troublesome mood problems; those with anxiety or depression, the risk of getting in to trouble with drugs is more likely as people will often “self medicate” trying to control moods that disturb them.

All drugs that are abused are mood altering substances. The most commonly abused substances are the legal and easily available drugs-nicotine, caffeine and alcohol. What percentage of people use these? Caffeine is the most widely used drug in the world with estimates as high as 80-90 percent of American adults and children engaged in regular consumption. How does caffeine alter mood? It can lead to increased energy, a sense of well-being, alertness and sociability. Like any drug, it has common side effects such as insomnia, stomach upset, headache and jitteriness. As with any drug there is a range of tolerance, sensitivity and dose dependent effect. Anyone who regularly uses caffeine is self-medicating with this common but effective drug.

NICOTINE, ANOTHER COMMONLY USED DRUG

The National Institute of Drug Abuse reported that in 2009 90 million adults and children 12 and older used nicotine regularly. That’s nearly a third of the total population! Nicotine is highly addictive and is the cause of 90% of lung cancer deaths and 38,000 preventable deaths annually. Nicotine can act as both a stimulant and a relaxant. It stimulates many neuro-transmitters in the brain and can cause a variety of positive effects including improved concentration, calmness, and alertness. It can reduce appetite and being an aid to weight loss. People who enjoy smoking, enjoy the effects it produces.

Cigarettes are inexpensive and easily accessible and are often consumed at young ages. People rarely take up smoking later in life as they have more knowledge and wisdom to understand the grave risks to health. Teenagers are mostly unconcerned about their long term health and are the likely to begin smoking to experience the desired effects of focus and calm.

The rate of smoking among people with severe mental illness is very high. Ask any of us who have worked in psychiatric facilities and you will learn that almost all patients are smokers. These people are self-medicating.

MARIJUANA

The most recent statistics on marijuana from 2010 showed that 17.4% of the population report regular use. This is about 7% of the population.  This rate is up from 8.7% in 2009 in reports from the Substance Abuse and Mental Health Services Bureau. Because it is an illegal drug some degree of under-reporting is possible even in anonymous surveys. People use marijuana for the calm and euphoric feeling of the high. Risks of use include anxiety and depression, lowered libido and infertility in men, paranoia and hostility. Smoking carries some of the risks of cigarette use. Despite the risks many people continue to smoke marijuana for self-medication; to relax, to reduce anxiety and tension and to help themselves forget their troubles.

MOOD ALTERING SUBSTANCES

Chemicals alter mood. This is a very simple fact. People use chemicals, whether they are legal such as caffeine and tobacco or illegal such as marijuana, cocaine, narcotics or hallucinogens to change how they feel!   And drugs do accomplish this. A common problem I encounter in practicing psychology is resistance to a psychiatric consultation when I feel psychiatric medications might be of benefit to my patient’s condition. People often have strong and irrational opposition even when they are regular users of alcohol, tobacco, caffeine or marijuana.

Why do people who abuse substances put themselves at considerable financial, occupational, social or health risks to use damaging drugs such as cocaine, amphetamines, narcotics etc?  Initially it is because of the good way these drugs make them feel. With continued time and use addiction itself becomes the primary driver but the change in mood for the time of immediate use remains.

Consider the successful professional who is a heavy user of cocaine. Even if they have lost their family, their money, their professional license they feel on top of the world when they get that hit of their drug of choice. The drug changes their perspective, their mood, their concern about the problems in their life. Drugs have the power to completely alter our feelings and perception.

SELF MEDICATION WITH DRUGS

So imagine you are a teenager who is shy or lonely or insecure. Perhaps you suffer from anxiety and worry too much about grades or peer acceptance. You lack the resources of an adult to change your environment and circumstances.  What is easier than to smoke a cigarette or take a drink or have a hit of marijuana offered by a friend? All of a sudden you feel calmer, happier, more in control of your life, more at ease socially. These commonly available drugs do provide those effects. They may cause terrible damage down the road it is true but in that moment they bring benefits. Cigarettes may cause an “early death” of 55 instead of 85. As marijuana use increases with it’s common effects of loss of motivation grades deteriorate, parental stress increases, temper may get shorter causing your social situation to get worse. If you choose alcohol your liver may be damaged in the distant future, you may lose control of the amount you drink jeopardizing career and income. BUT in the moments, at that party, with that boy or girl you’re attracted to, with that bully who makes you feel small you feel stronger, more confident or less anxious about any of the downsides. The cycle has begun.

MIND OVER MOOD

Recent statistics estimate that about 10% of the population suffers from some form of depression. 18% suffer from anxiety disorders. These are the most common mood disorders and a higher percent experience these transiently as opposed to chronically. The fastest, simplest way to change these feelings-legal or commonly available drugs such as alcohol, caffeine, tobacco or marijuana. These are far easier and less embarrassing to access than psychotherapy, psychiatric treatment or prescription medications. They require less planning and forethought. So they are often a drug of choice for self medication. Those with more severe forms of mental illness who suffer more unbearable thoughts and feelings can easily be at higher risk of substance abuse as they seek to change the terrible way they feel. People who develop alcoholism, addiction to narcotics, amphetamines and other dangerous drugs often began their journey with self-medication; an easy and quick way to change how they feel.

Not all drug abusers initially suffered from mental illness. A shy teenager is not mentally ill but teenagers as a class are at a higher risk for substance abuse due to their inherent insecurity and vulnerability. For those truly struggling with anxiety, depression, the impulsivity and restlessness of ADHD self-medication is often the first and often ultimately disastrous effort to change and make things better.

So self medication is real, it’s just not often effective or successful. Thoughtful treatment, provided by a skilled professional can lead to long term improvements in most disorders as well as reduce the damage of more severe mental illness.  Modern psychiatric medications have the power to improve many conditions and together with psychotherapy can improve lives far more effectively than the hit or miss approach of self medication with drugs that have the potential to make life not better, but a great deal worse.