Self-medicating

Given the abundant evidence linking problem substance use to adverse life circumstances and events and mental health (see adverse childhood experiences; see trauma), it has been inferred that problem drug use, for some people, is a form of self-medication or coping mechanism. For some, the use of drugs makes what may seem overwhelmingly unpleasant situations bearable.

Interestingly the drugs people use may indicate the very form of unpleasant circumstance or symptom they are trying to medicate for. For example, people with attention deficit disorder (ADD) may self-medicate with stimulants and report that ‘I need cocaine to feel normal’. What is actually happening is that the person is experiencing a paradoxical effect from the stimulant which they experience as calming and allowing them to focus and concentrate. Under different circumstances, people with ADD are often prescribed a stimulant (Ritalin, for example) and this paradoxical effect is well-documented in medical literature.

Likewise, people who suffer from anxiety or have problems sleeping may use benzodiazepines to alleviate these experiences – and these drugs are in fact prescribed for people with similar issues. In these cases, the drug use mimics and replaces the medication they may have been prescribed by a doctor. Early engagement with primary care or specialist services may have prevented this kind of drug use which can become very problematic and last for years.

People who use heroin describe the experience of it ‘blotting out everything’, insulating them from physical pain and from intrusive thoughts or anxiety. People describe early use of heroin as like being hugged or wrapped in a warm blanket. The comforting, protective nature of this experience is profound, especially for someone who otherwise lacks that comfort or has anxieties around building trusting relationships or is traumatised. (See drug of choice; see adverse childhood experiences; see trauma)

People who have a substance use problem involving alcohol sometimes report that the disinhibition that alcohol use involves allows them to engage in social situations or that it ‘blots out’ intrusive thoughts associated with trauma or that it helps them sleep.

The model of problem substance use as self-medicating is also demonstrated in cases where, when people reduce or cease their use of substances, for whatever reason, significant issues arise in terms of their mental health. This can happen also when OST medication is reduced. For a person using street drugs, without access to other support, there is a strong drive to increase the amount of drugs they use. This helps explain the relapsing nature of problem drug use (see relapse). For a person on OST these experiences can mean that their dose of medication is increased again. This explains why people are on medication long term and it can be difficult to come off OST (see ‘parked on methadone’).