A Better, More Humane Understanding of Addictions

Self-medication is an oft-used term that when explored deeply, lends a better understanding of substance use disorders and defuses stigma. Stigma is born from judgment, limited experience of those with substance use disorders and a lack of understanding what drives substance misuse to being with.

Research shows that in the majority of cases, it’s trauma. Trauma creates painful memories and emotions; substances dull that pain. This sets forth a pattern that the substance user gets stuck in: he uses alcohol and/or drugs to medicate his emotions. Then, he becomes habituated and the substance use creates further pain along with more negative emotions, lacking other coping skills, he continues to self-medicate which creates more pain and then more self-medication.

Ed Khantzian developed the “self-medication hypothesis” (SMH) in the1980’s to help explain the phenomenon of addiction. While there are many factors in developing substance use disorders, including genetic, environmental and developmental, SMH posits that people seek specific substances to cope with “negative affect states,” or painful feelings. Those with anxiety tend to medicate with drugs that tranquilize such as alcohol or benzodiazepines. Those with depression may favor stimulants such as cocaine or methamphetamine. While this is a hypothesis, it always rang true to me as a person in recovery and more so in my thousands of interactions with addicts and alcoholics as a clinician.

Case in point, me. Growing up in an alcoholic home, my father’s kicks, slaps, punches and daily verbal abuse left me angry, ashamed, depressed, anxious and with tattered self-esteem. At age twelve I discovered alcohol. My first buzz was magical in how it ameliorated my internal pain instantly. I was able to banish my self-consciousness and socialize with others. I felt a kinship with other kids from alcoholic homes who also were discovering substances and enjoying their effects. In short, I fell in love with the warm, safe, encompassing embrace of alcohol.

In the early days of our using lives, we had great fun but self-medication extended for too long leads to habituation and addiction, which then leads to pain and destruction. That coping pattern evolved into a reliance that deepened and progressed to the point of self-destruction. It required deliberate change and support to overcome.

At twenty-eight, my addictions had denuded me of everything decent in my life: my financial health, a marriage and custody of my daughter. Substance use disorders prevented me from getting anywhere near my potential. I was worse off than I was at eighteen. Despairing and feeling hopeless I finally sought help from an experienced substance use disorders clinician who helped me find treatment and get into recovery. Experienced clinicians tailor treatment to help clients practice emotional regulation, trauma processing, and better self-care including sleep, exercise, social support and/or mindfulness.

Recovery restored all of my addiction related losses and then some. I discovered my talents and was able to form lasting healthy relationships, including a marriage and family.

Things that other people said about me, things that stigmatized me turned out to be false: “he’ll never change,” or “he’s just like his father” or “he’s just a drunk/junkie.”  Nobody saying those things had any understanding of the travails of my childhood. I know that some had it worse but my childhood was quite traumatic. Every alcoholic addict I’ve ever met has internalized shame that is often perpetuated by many of the people around him/her. The shame prevents the substance user from recognizing his latent abilities and from accessing treatment and recovery.

In short, stigma perpetuates addiction. I believe that every addict/alcoholic has the ability to recover. Recovery restores the user to his emotionally and physically healthiest self and provides him with the ability to cope organically with his negative emotions. One goes from the margins of society to a more significant role. Recovery enables the addict/alcoholic to realize his potential. Doesn’t it make sense to better understand, invest in and encourage those with substance use disorders accordingly?

Read more about thew Self-Medication Hypothesis here:

https://www.psychiatrictimes.com/view/theory-self-medication-and-addiction

Read more about the link between trauma and addictions here:

https://www.psychologytoday.com/us/blog/understanding-addiction/202109/why-trauma-can-lead-to-addiction

Previously Published on substack

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