“What do you want to do tonight?” said a man on a sidewalk in San Diego. “I don’t want to get super trashed.” said another man leaning against a wall. “I want to get up and work out in the morning. I want to get my life back on track. But I want to get trashed tonight.”
When we hear “self-medicating,” we tend to think of people with deep psychological issues. People who smoke five packs a day, get drunk before noon, or shoot heroin to make their problems go away, at least temporarily. In other words, people who aren’t like us.
But what if they are?
After all, who hasn’t drunk three cups of coffee to make it through a workday, savored a glass of wine after a stressful day, or eaten a pint of ice cream after a breakup? Though perhaps not on par with heroin, isn’t the intention the same—to relieve difficult emotions? And isn’t it possible that our behaviors also mask deeper issues?
In this article, we’ll look at why and how we self-medicate and explore potential alternatives for working with emotional pain.
First, let’s define what it means to self-medicate.
Self-medicating is exactly what it sounds like: using non-prescribed drugs to treat psychological ailments. Wikipedia defines a drug as “any chemical substance that causes a change in an organism’s physiology or psychology when consumed.”
Heroin use was the original focus of research, but today all drugs and alcohol are included in self-medication theory. But wait, if activities like social media, TV, and food also alter our physiology and psychology, shouldn’t they too be included?
After all, isn’t that why we eat doughnuts, gamble, and watch porn—to alter our psychological state? And isn’t it true that almost everything we do an attempt to feel good while avoiding feeling bad?
Look at how we live. In the morning, we stimulate our minds with caffeine; take ibuprofen in the afternoon for back pain, and drink a beer or glass of wine in the evening to tranquilize our overstimulated minds after a crazy-busy day. In other words, many of us are drugged 24/7.
“Everything we do,” writes Sam Harris, “is for the purpose of altering consciousness.”
Even the Buddha understood this truth 2,500 yrs ago. To paraphrase, he said,’ The only way humans know how to deal with difficulty is through sense pleasure.’
Generally speaking, people self-medicate for two primary reasons:
1. To relieve symptoms and make distressing experiences more manageable.
2. Lack of awareness of alternative ways of coping with one’s feelings.
Addictive behaviors compensate for underlying issues that haven’t been adequately treated. Self-medicating provides temporary relief from mental illnesses, psychological trauma, and emotional distress such as anxiety, loneliness, depression, and shame. In sum, they allow us to avoid the oppressive thoughts and uncomfortable feelings of being with ourselves.
The drugs we choose aren’t accidental. We take them for their ability to ease our particular distress. People who get bored tend easily to take so-called uppers to feel stimulated. While people who have difficulty dealing with reality are more likely to choose so-called downers, which tranquilize them and neutralize their emotional pain.
Interesting drug
The one that you took
Tell the truth, it really helped you
An interesting drug
The one that you took
God, it really, really helped you - Morrissey
“We’re desperate to feel less or more of something,” writes Brené Brown, “—to make something go away or to have more of something else. Shame, anxiety, and disconnection are big drivers of numbing behavior, but “numbing vulnerability also dulls our experiences of love, joy, belonging, creativity, and empathy,” continues Brené, “We can’t selectively numb emotion. Numb the dark and you numb the light.”
In high school, I suffered from social anxiety. At house parties, I’d walk straight from the front door to the garage (which keeps a keg cold during Minnesota winters) and drink two beers before joining the party. Drinking reduced my inhibitions, allowing for sociability and humor. Of course, anyone who went into the garage for a refill inevitably asked, “What are you doing hanging out in the garage?”
“Almost all of us are addicts. Not injecting heroin as such, but addicts in the sense—we need to redefine what addiction is. I like to define addiction, not in terms of the substance you’re taking. In other words, you know I’m a heroin addict, I’m a cocaine addict. Addiction is basically any pattern of behavior whereby you cannot stand to be with yourself and certain of the more uncomfortable thoughts, and more importantly, emotions that come from being on your own. And so therefore you can be addicted to almost anything so long as it keeps you away from yourself. So long as it keeps you away from tricky self-knowledge. Most of us are addicts, and thanks to all sorts of technologies and distractions, etc. We can have a good life where we will almost certainly be guaranteed not to spend any time with ourselves. And this is a disaster for your capacity to have a relationship with another person.” - Alain de Botton
Let’s look at some of the most common ways we self-medicate.
People look in each other's medicine cabinet. Why? Because seventy percent of Americans have at least one medical prescription, 50% have two or more, and 20% have five or more. A staggering $350 billion (or about $1,300 per person) is spent annually filling four billion prescriptions.
Over five percent of U.S. adults (or 13 million people) abuse prescription drugs, including three million who abuse opioids, the most commonly abused medication. More people die of prescription drug overdoses than heroin, cocaine, and methamphetamine use.
"Kids are different today, " I hear every mother say
Mother needs something today to calm her down
And though she's not really ill, there's a little yellow pill
She goes running for the shelter of her mother's little helper
And it helps her on her way, gets her through her busy day - Rolling Stones
Drugs like Adderall and Ritalin, designed to treat ADHD and affect less than three percent of the population, are used by up to 38% of college students to aid in studying. The pharmaceutical industry, for its part, spends $6 billion annually, reminding us that relief is just a pill away.
About 90% of Americans start their day with caffeine, whether coffee, tea, soft drink, or energy drink.
Seventy-five percent of U.S. adults (or approximately 160 million) drink three cups of coffee daily, second only to water. Another 160 million drink tea, not including the eight billion cans of Red Bull consumed annually, making caffeine American’s most popular drug. Yes, caffeine is a psychoactive drug.
“You could say this nation runs on two dark liquids—petroleum and coffee," says professor Bob Thompson. Caffeine is the world’s most widely consumed mood-altering drug, far exceeding alcohol and nicotine use, believes Roland Griffiths, a leading caffeine researcher. Perhaps that makes Starbucks, which serves three trillion cups of coffee annually, the world’s largest legalized drug dealer.
You can even buy mugs, t-shirts and notebooks with phrases like “You may call it coffee I call it my emotional support beverage” or “I don’t need therapy, I just need my coffee.”
So why do we love caffeine so much?
For “caffeine’s luscious byproduct, productivity,” writes Amy Krause Rosenthal, “Ah, the joy of doing, accomplishing, crossing off.” “Think about it,” says Michael Pollan, “Your employer gives you a drug and then gives you time off in which to ingest it during the workday. Why would they do that? The coffee break might seem like something your boss is giving you, but it’s a way to extract more value from you.”
Our obsession with productivity is mainly driven by anxiety, the very thing that spurs productivity. Caffeine helps us get more done, keeping our anxiety in a kennel. Coffee also makes us feel good. “I drank this drink [coffee], and it was so good.” says Pollan, “I mean, I just felt these waves of well-being, and then it turned into euphoria. Wow, this is such a strong drug. I had no idea; it was like cocaine or something….”
How does caffeine work?
Caffeine, a naturally occurring insecticide, wakes us up by occupying receptors generally reserved for adenosine, the chemical that induces sleep. By hijacking these receptors, caffeine tricks us into feeling alert, despite high levels of adenosine in our system.
Caffeine also boosts dopamine, which controls our ability to focus, stimulates the central nervous system, and acts as an antidepressant. “The consumption of caffeine,” writes Matthew Walker, “represents one of the longest and largest unsupervised drug studies ever conducted on the human race, perhaps rivaled only by alcohol.”
According to the National Institute on Alcohol Abuse and Alcoholism, 85.6% of Americans report drinking alcohol at some point in their lifetime, 69.5% in the past year, 54.9% in the past month, including 25% binge drinking in the past month.
The average drinker consumes three drinks per week, while the top 30% average six drinks per week and the top 20% 15 drinks per week. Eighteen million Americans are addicted to alcohol. In one survey, 53% of respondents had checked themselves into rehab, or more than the total for prescription pain medication, meth, cannabis, heroin, cocaine, and crack combined.
Studies show people drink for two primary reasons:
1. Stress reduction and
2. Socializing
Alcohol relieves emotional tension—anxiety, depression, mood disorders, trauma, and PTSD—by softening our defenses and allowing people who are otherwise cut off from their feelings and relationships to experience affection and closeness with others.
Unfortunately, alcoholism can be complicated to overcome, requiring months or years of recovery.
The stats on smoking are unsettling. Despite several decades of anti-smoking campaigns, 20.8% of U.S. adults (or 50.6 million) still consume tobacco.
Forty percent of smokers suffer from mental disorders, 25% are below the poverty level, 24% don’t have a diploma, and 21% have a disability. People with depression are twice as likely to smoke, and people with schizophrenia, bipolar, or PTSD are five times more likely to smoke. Tobacco users make up 65-85% of patients in addiction treatment.
People use nicotine (the active ingredient in tobacco and a naturally occurring insecticide) for many reasons, including alertness, calmness, and improved cognition and focus. Nicotine speeds up messages between the brain to the body. It only takes seven seconds for nicotine to travel from the lungs to the brain, providing instant relief from emotional pain. That’s one reason nicotine is so addictive.
One study found that smoking is often justified through cognitive dissonance:
"Smoking calms me down when I am stressed or upset."; "The medical evidence that smoking is harmful is exaggerated."; "One has to die of something, so why not enjoy yourself and smoke?"
Smoking increases the likelihood of dying from lung cancer by 50%. Other problems of nicotine use include decreased brain activity, depression, impatience, anger, anxiety, trouble sleeping, trouble concentrating, restlessness, boredom, headaches, tiredness, and weight gain.
With 49.6 million users (and four million addicts), cannabis is the most popular recreational drug in the U.S.
One study found that seven percent of high school students use cannabis daily or near daily. Teens generally use cannabis to manage moods, be accepted by peers, and cope with boredom, stress, anxiety, and depression.
Studies link cannabis use with lower IQ, reduced athletic performance, impaired driving, congenital disabilities, depression, anxiety, suicidality, relationship problems, worse educational outcomes, lower career achievement, and reduced life satisfaction.
While cannabis may help us feel better temporarily, it doesn’t come without consequences.
According to the 2020 National Survey on Drug Use and Health (NSDUH), a yearly survey of the Substance Abuse and Mental Health Services Administration (SAMHSA), 21.4% of Americans (or 59.3 million people) used illicit drugs in the past year.
In 2017, 8.5 million American adults suffered from mental health and substance abuse disorders. In the past year, 5.2 million people used cocaine, 1.5 million used methamphetamines, 1.5 million used inhalants, and 1 million used heroin.
Again, people’s choice of drugs is not accidental. Cocaine provides a sense of euphoria and is often used to mask depression, hypomania, and hyperactivity. On a lighter note, the Drug Enforcement Agency keeps a humorously long list of Slang Terms and Code Words for illicit drugs.
Fifty-eight percent of Americans have watched pornography, including 27% in the past month. According to PornHub’s 2019 annual Year in Review, four billion hours of pornography were consumed over 42 billion visits to its website.
People use porn for eight common reasons: boredom, emotional distraction or suppression, fantasy, lack of sexual satisfaction, self-exploration, sexual curiosity, sexual pleasure, and stress reduction.
Eighty-five percent of U.S. adults have gambled at least once in their lifetime, including 60% in the past year. Of those, two million (or about 1%) meet the criteria for severe gambling problems, while another 4-6 million (or 2-3%) have mild or moderate gambling problems.
“Welcome to the house of addiction.” - Croupier
The states: “Gambling can stimulate the brain's reward system much like drugs or alcohol can, leading to addiction.” According to Frontiers, the 6th most prominent publisher of research, “compulsive behaviors such as uncontrollable gambling, can be viewed as forms of self-medication…”.
Gambling is about excitement, the thrill of making money without working. Throw in a negative self-image that wants you to self-destruct yet is lurking in the shadows of your mind, and you’re vulnerable to addiction and losing everything.
Statista states that 4.5 billion people (or 56% of the world’s population) use social media, the same percentage with access to the internet. An eMarketer study found that U.S. adults spent an average of 7 hours and 50 minutes daily on smartphones, desktops, and other devices consuming digital content and engaging in online apps.
"In our culture, addiction has become the most common way to deal with pain. We watch television incessantly. We keep busy, running from one activity to another. We work seventy hours a week, indulge in pornography, overeat, drink, take pills—anything to help us avoid the pain. Some of the demand that someone or something (a marriage, sexual partner, and ideal family, children, and achievement, a career, or a church) take our loneliness away.” — Peter Scazzero in Emotionally Healthy Spirituality
A recent survey found that “filling spare time” (36.3%) was the second most common reason for using social media. Research shows that social media is linked to anxiety, stress, emotional exhaustion, depression, loneliness, envy, low self-esteem, low-quality sleep, and health problems.
Additionally, A.C. Nielsen Co. research shows that the average American watches four hours of TV daily, or 11.4 years over our lifetime (or 100,000 hours). When we look back on our lives, I wonder if we would rather have spent that time reading another 13,000 books or watching endless “reality” TV reruns.
Seventy percent of Americans are overweight, and 40% are obese, with one study concluding that the “prevalence of food addiction is increased in obese individuals.”
Psychology Today states, “Stress, loneliness, and boredom can trigger the desire to choose fatty, sugary, or salty foods instead of healthier, more nutritious options.” Studies show that foods containing high fat or high sugar act similarly to cocaine and heroin in the brain.
“Comfort eating” may temporarily reduce stress, a study suggests. But binge eating can negatively impact self-esteem and make symptoms of mental illness worse.
“You can eat compulsively, just as you can smoke or drink or do drugs compulsively,” Jeffrey Kluger writes in a Time magazine article on food addictions. “And in all those cases, compulsions can become full-blown addictions, as repeated exposure plays the pleasure centers in the brain, creating a feedback loop of craving, indulging, consuming, regretting—and doing it all over the next day and the next.”
Fortunately, individuals can learn how to stop self-medicating. Here’s how.
When we deny our pain, ignore the things we should be doing, and instead rely on substances and distractions, our self-esteem takes a hit. Self-care is about learning to stand on our own two feet without needing mental and emotional crutches.
There are many ways to stop self-medicating, but here are some of the most common strategies. Please note that I am not an addiction expert. If you think you have an addiction, please seek professional help.
I felt profoundly lonely when I was married and desperately wanted someone to talk to. But talking with mutual friends and family members felt like an act of betrayal. Instead, I suffered in silence. We divorced several years later.
Talking about life’s difficulties with a safe friend is a cornerstone of well-being. It allows us to open up and share our pain to be heard and understood. Being seen and having our feelings mirrored back normalizes our experience and helps us feel more connected and less alone. More importantly, research shows that early intervention is the most effective way to help someone with a possible substance use disorder.
If you own your feelings and speak from your heart, what you say can’t harm the other person but can help you.
Avoiding pain and vulnerability only creates more sorrow and suffering for everyone. The more we use distractions such as TV, eating, and social media, the less we know ourselves—our thoughts, moods, beliefs, and behaviors.
Staying with painful emotions and learning to locate, name, and release feelings can be transformative. Without the words to describe our experience, we remain stuck in the darkness, not understanding what we’re feeling or why. Observing and expressing our experiences adds richness and color to life and grounded confidence.
In a future article, I’ll write about how to develop emotional intelligence, a profoundly important skill.
Many studies show that meditation helps us regulate emotions and manage addictions. Meditation lets us objectively observe difficult emotions and feelings, leaving us more grounded and centered. We can make decisions from a more rational rather than frantic space.
Meditation is one of many ways to quiet the mind and restore emotional balance. Other means include walking, sitting in the backyard, or going for a drive. What you do is less important than doing it. When asked about using a Waterpik, my dentist replied, “I recommend whatever you’ll use."
For years, I thought rigorous spiritual practices were enough to mature fully and work through my childhood wounds. Yet, as beneficial as spiritual practices are, they can only take us so far.
Working with therapists over the years has been nurturing, affirming, and healing and has allowed me to dissolve much of the shame, guilt, and low self-esteem that plagued me for years. More importantly, research shows that cognitive behavioral therapy effectively treats substance use disorders.
“All compulsive and addictive behaviors are attempts (sometimes desperate attempts) to avoid certain repressed feelings from childhood trauma. Mood-altering substances, certain activities, and focusing on taking care of other people allow only a temporary reprieve from experiencing these old, scary feelings.” - Flight From Intimacy
If you suffer from childhood trauma caused by abuse or neglect, you may benefit from the therapeutic effects of working with a therapist, counselor, psychologist, or psychiatrist. Local counties and not-for-profits often offer services at discounted rates. Just be sure to find the right therapist for you.
Over the years, I’ve found solace in various spiritual and personal development communities. They have been incredibly beneficial in discovering that I wasn’t alone in suffering from confusion, self-hatred, and crippling self-doubt.
An ongoing support group can provide a safe place for normalizing your experiences and behaviors and for healing through sharing your sorrows and listening to others’. Additionally, “Peer support groups included in addiction treatment show much promise in potentially reducing substance use.”
One of our life tasks is to give our gift to the world before we die. “Purpose is an essential element of you. It is why you are on the planet at this particular time in history,” said Chadwick Boseman, “Your very existence is wrapped up in the things you are here to fulfill.”
I agree with Steven Pressfield, author of the War of Art, that if we do the work we were put on this earth to do, much of our use of “drugs, shopping, masturbation, TV, gossip, alcohol, and the consumption of all products containing fat, sugar, salt, and chocolate” would disappear.
Working on something purposeful beyond work and raising kids, regardless of the outcome, is intrinsically satisfying. It harnesses our attention and dissolves the mind’s tendency toward negativity and pettiness.
In the U.S., the Substance Abuse and Mental Health Services Administration (SAMHSA) has a National Helpline offering free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and substance use disorders: 1-800-662-4357. SAMHSA also offers an online Behavioral Health Treatment Services Locator.
UK: Call the SANEline at 07984 967 708.
Australia: Call the Sane Helpline at 1800 187 263.
Canada: Visit Mood Disorders Society of Canada for links to provincial helplines.
India: Call the Vandrevala Foundation Helpline at 1860 2662 345.
Clean, the cleanest I've been
An end to the tears and the in-between years
And the troubles I've seen
Now that I'm clean, you know what I mean
I've broken my fall, put an end to it all
I've changed my routine now I'm clean
I don't understand what destiny's planned
I'm starting to grasp what is in my own hands
I don't claim to know where my holiness goes
I just know that I like what is starting to show
(Sometimes) - Depeche Mode
Everyone self-medicates in different ways and to different degrees to cope with life’s challenges. Some amount is okay, yet chronically avoiding pain not only robs us of our humanity but also denies us the opportunity to grow and become more resilient.
If you’re addicted to alcohol, drugs, or nicotine, sooner or later, you will have to face letting go of that substance one day at a time. But with other types of addiction and compulsion, establishing balance can be helpful.
Living life in balance will feel different. You will have to face your feelings when you stop masking your moods. How well you learn to work with those feelings will determine if you can live free of addictions and compulsion. That’s reality.
Difficulty is part of life. The question is, will you choose short-term symptom relief or long-term personal growth?