“Addicts are attempting to medicate themselves for a range of psychiatric problems and painful emotional states. It’s little wonder that addicts refer to their dealer as their fix. So, it’s a metaphor that really says what it is, it’s a fix for something that is not right in the person.” (Edward Khantzian, professor of psychiatry Harvard Medical School and founder of the American Academy of Addiction Psychiatry)
“There’s a reason people like me choose marijuana. I need something to help me stop being so crazy and stressed out,” says Nancy, a thirty-one year old scientist who was addicted to marijuana for six years. “I’m naturally very high strung and weed would make me a lot calmer and less anxious. I didn’t feel normal or sane without it. I felt on edge. But, on weed, I felt great all the time, that is until it stopped working and it actually made me anxious.”
According to the self-medicating hypothesis, people like Nancy do not just stumble upon a drug that works for them. They randomly, “experiment with various classes of drugs and discover that a specific one is compelling because it ameliorates, heightens or relieves states that they find particularly problematic or painful,” writes Dr. Edward Khantzian. He is the author of, Understanding Addiction as Self-Medication: Finding Hope Behind the Pain.
Khantzian refers to a patient who was a celebrity athlete turned rock star who suffered from both posttraumatic stress disorder (PTSD) and bipolar mood disorder: “He was subject to verbal tirades with his wife. He described, ‘how heroin was like putting on a warm fuzzy blanket.’ The anger went away, no matter what the conditions, when he was under the influence of the narcotics.”
Heroin is a narcotic, which is in the opioids family, along with opium, codeine, morphine, fentanyl, oxycodone (Oxycontin), Vicodin and Percocet.
Khantzian condenses the responses he has had for over forty years from patients hooked on narcotics. “Doc, I felt calm for the first time. I felt normal. I had a lot of angry feelings. My angry feelings went away. I felt much more comfortable in my skin.”
One person might use opiates to calm rage or resentment. Another person might use cocaine, a stimulant, to battle depression. “I’ve been repeatedly impressed how this energizing and activating property of cocaine helps such people, who have been chronically depressed, overcome their anergia [abnormal lack of energy], complete tasks and better relate to others and, as a consequence, experience a temporary boost in their self-esteem,” explains Khantzian, adding, “It’s a short-term fix … but a long-term confounding, tragic choice to deal with one’s troubled feelings and troubled states of being.”
Randy, a 59-year-old nurse with ADHD, says cocaine worked for him: “Marijuana would sedate me and cocaine would stimulate me, but help me to focus. It was like taking Ritalin, which I took as a teenager for a couple of years, until I started abusing it.”
Other stimulants include methamphetamines such as crystal meth, Ritalin, Dexedrine, Adderall and MDMA (ecstasy).
Khantzian says a stimulant can appeal to those who are bored, lethargic, depressed or suffer from poor concentration. Stimulants can also counter restlessness, hyperactivity and inattention for people with ADHD.
Dr. Anthony Ocana is an addiction specialist in North Vancouver, Canada, with 23 years experience. He says he sees many clients hooked on cocaine who are bipolar, narcissistic or have borderline personality disorder. He believes in the self-medicating hypothesis: “Every drug has different effects in different dosages in different people. In each person—the alignment between their brain and the drug is not random. They have found that a particular drug works for them and they continue to do it until it gets out of control and they get addicted.”
Ocana witnesses many patients using stimulants such as methamphetamines as a form of self-medication. “Patients often relate a story that they can’t get things done because they have underlying ADD [ADHD]. Then they use some methamphetamine, specifically to clean their house, specifically to do their paperwork.”
Alcohol and Benzodiazepines
“There is self-medication which is safe and perfectly in control. The difference between the addict and the non-addict is the addict loses control.” Ocana gives the example of a shy, young woman who goes to a party and has a couple of drinks: “Suddenly she’s not so shy. And you can use that in a therapeutic way or it can get out of hand and have negative consequences.”
“People don’t use alcohol for some random reason,” says Ocana. Alcohol effects people in three specific ways: “…as uppers in some people, mood stabilizers in some people and an anxiolytic [anti-anxiety] in others.”
Benzodiazepines are central nervous system depressants like alcohol. They include such drugs as diazepam (Valium), Ativan, Xanax, Clonazepam and Rohypnal.
Ocana says people self-medicate with benzos for the same reasons they self-medicate with alcohol: “People become mini-pharmacologists early on in their lives. They use it specifically because it works and they figured that out when they were 15 and ever since they were 15 they use that drug that way to get a certain outcome.”
According to Ocana, different people buy different strains of marijuana for
different purposes. If they are using cannabis daily as self-medication, they don’t buy it randomly: “If a patient smokes sativa, test for ADHD. If they smoke indica, you should look for mood dysregulation or sleep disorders. So, people will experiment until they find the strain and the blend that works for their brain, and if they’re heavy users, they know exactly what they’re using.” If the user does not know what strain they use then, “those are the people who are using it recreationally.”
Khantzian admits that addiction is complicated and the self-medicating hypothesis does not discount the myriad of other factors that contribute to addiction: “It’s not intended to substitute for socio-cultural and biogenetic theories in explaining … substance related disorders.”
Henry is a 53-year-old house painter who is 10 years clean from crack cocaine. When he was a teenager he became addicted to alcohol and pot. After many suicide attempts he “started to self-medicate with crack cocaine. That gave me a euphoric feeling and gave me a reason to live. At least I wasn’t thinking about killing myself. I went to see a doctor and he asked me, ‘Do you smoke cigarettes?’ I said, ‘Yes, I do.’ He asked me, ‘Do you drink coffee?’ I said, ‘Yes, I do.’ He asked me, ‘And you smoke crack cocaine?’ I said, ‘Yes, that’s right.’ He said, ‘I can almost guarantee that you’re self-medicating for depression.’”