Trying to medicate your issues with alcohol or drugs may work in the short run, but you might be setting yourself up for an even worse problem. Some of the worst causes of substance abuse and addiction happen when people try to treat an undiagnosed or unacknowledged problem alone by using alcohol, prescription medications, or non-approved drugs. A person can ruin his or her life, the lives of others, and create problems that make the original situation worse. There are so many conditions that need a skilled diagnosis and an appropriate treatment plan. The best plan of action is for the person to acknowledge first that a problem exists. Second, that person should go to a therapist and a physician if medication is necessary. Several examples will show these dangers and how to begin to solve problems. These examples are drawn from my work as a psychologist.
I got an urgent call from a woman named Joan (not her real name). She needed a psychological evaluation as soon as possible. I asked her why she needed it so soon and for whom it was intended. She said she needed it for her licensing board. She was on probation and she needed it to stay on probation.
I asked her what had happened. She said she had been busted for possession of methamphetamine. She went on: “I didn’t realize I had it in my pocket. I had been partying with old high school friends and I got on an airplane.” She went on to tell me that she had served her time as a result, but that her licensing board had found out about it. That’s how she got the probation.
So I evaluated her. Yes, she had been a meth user in her early twenties. She also drank a lot. Yes, her parents had been substance abusers—her father was an alcoholic and her mother was a pill popper. Yes, her brother had physically and mentally abused her. She also said that she had gone to therapy as a result of the arrest and had been diagnosed as having ADHD (attention deficit hyperactivity disorder), alcohol abuse, and PTSD (post-traumatic stress disorder). I asked her if she knew she had ADHD as a child. No, she said, though she did tell me she had school problems. I asked her if the meth helped her focus or got her high. She said that if she took a lot of meth, it got her high. Right now she was on anti-depressants prescribed by her psychiatrist. And she was only socially drinking.
I asked her if she thought she had used meth to help her focus. She had never thought of that. Yes, it did. She also said that she also was no longer drinking hard liquor and was going to therapy. I gave her some material about ADHD and also told her that her alcohol use could affect her anti-depressants. When I wrote her evaluation, I said that she should continue both medications and her psychotherapy.
What happened with Joan is very typical of the dangers of self-medication. In her case, she had two undiagnosed and untreated issues. The first was ADHD. Like many people, Joan used an upper. In smaller amounts, it helped her focus. In larger amounts, it also made her high. She also “used” a lot of caffeine-in coffee and sodas. Caffeine is an upper and helps some people focus. It is often a “gateway” drug for kids with undiagnosed ADHD. You can see many of them drinking caffeine-laden energy drinks to help “solve” their focusing problem.
The second was PTSD and other underlying depression. These conditions had arisen from her childhood. She had gone to counselling only minimally and had broken it off. So she drank in addition to using meth. The legal drug alcohol helped in terms of her depression. Because alcohol is a two-stage drug, it first acted as an upper and lifted her mood; then it acted as a depressant, masking her underlying depression. She continued to drink, making her go up and down at the same time. The meth made her feel up. Together with the alcohol, they affected her moods, with bad side effects, unpredictable at times.
In simple terms, Joan should have gone to therapy, dealt with her childhood-caused depression and PTSD, had her ADHD diagnosed, and taken the appropriate medications if warranted. Joan’s case is like many others in terms of problems resulting from self-medicating. At one diversion program where I worked, many of the residents had undiagnosed panic disorder, ADHD, anxiety, depression, bipolarity, and other disorders. Partly because they lived in a rough drug-using world, they used illegal drugs. They often found relief when they used speed, crack, downers, alcohol, and prescription medications like illegally obtained pain pills.
These drugs and medications caused several problems. The pain pills have serious side effects. Pain pills usually cause constipation, irritability, and may cause or enhance paranoia. Alcohol also can cause irritability and paranoia. By themselves or taken together, they can cause a person to misjudge a situation. The people with whom I worked were in a violent, tough world. They fought, they hit each other in the head, and they fell down. Many had head trauma, untreated and undiagnosed. Moreover, as alcohol abusers often find out, blackouts occur when they drink too much. Blackouts also occur when they fall down and hit their heads. People can experience head trauma when they hurt their heads. People with head trauma have poor impulse control difficulties, leading to even more fights and more trauma—and more drug usage. And they can get into legal trouble, making their lives even worse. They then have to deal with a much more complicated world. When I worked with them, I tried to diagnose them as accurately as possible and send them to the appropriate psychiatric and psychological resources for further treatment. Many of them were surprised by knowing now “what they had” and what might have caused them to have problems.
These aren’t the only examples of the dangers of self-medicating. Paul—not his real name—has PTSD from an abusive childhood, is bipolar, has ADHD, and has significant and recurrent medical problems, often with resulting pain. He is also over 60. When I first saw him, he wanted to discuss his childhood trauma. Quickly, however, he explained that he and his wife were having problems because “…she didn’t understand…” his ADHD. Then he started cycling in terms of his bipolarity. To top it off, he required surgery. But before that, he had a serious infection which also caused him a lot of pain.
Paul was taking prescription medications for the bipolarity and the ADHD. It was not an easy balance. The medication he was taking for bipolarity was a mood stabilizer; the medication he was taking for ADHD was an upper. Often times they didn’t work right together and he got a bit more manic than he should have. When he started feeling pain, he took a pain pill, which is often a downer. That made him somewhat depressed—and cranky. It also triggered some of the PTSD from childhood. Because he was over 60, he often experienced more intense and paradoxical reactions. He consulted with his doctor, who told him to do the best he could. Often he played around with the medications to try to compensate. That didn’t always work and it created more problems at home. The crankiness also made his relationship worse.
Paul’s dilemma is typical for many people: they are prescribed medications, but they use the medications in their own way and get disastrous results. They then complicate their reactions by drinking, smoking, excessively using caffeine, and drinking alcohol. They also take “natural” supplements. They don’t always tell their doctors and doctors don’t always ask. These supplements can have serious side and interactive effects, creating psychological and physical problems. For example, Paul’s wife was almost ready to leave him because of his moods.
There are other examples of the dangers of self-medicating. One may become dependent and addicted to a legal or illegal drug. Consider the case of Carol—not her real name. Carol, in her mid-40s, was referred by her doctor. He said that he had run out of ideas as to what to do with her. When we first met, she complained of headaches. I called the doctor. He said that there was no medical cause for her headaches. They weren’t migraines, for example. I asked her about her drinking. She said she drank ten glasses of wine a day. I asked whether it was red or white. She said it was white, which was “better,” because, for many people, red wine can cause severe reactions. I asked her why she drank. She said she drank because life was hard. She added that she drank before she went to sleep and that she slept badly.
I diagnosed her as having underlying depression. I told her to stop drinking (and I told her doctor that she probably had headaches in part as a result of the drinking.) I told her not to drink before sleep because alcohol disrupts one’s sleep. I also told her to cut out late coffee because caffeine is an upper, only gradually wears off, and can adversely interact with the alcohol. I also recommended that she cut out cigarettes. Cigarettes can work in two different ways. If you smoke fast, they act as an upper. If you smoke slowly, they act as a downer. They affect your reactions if you are using other “drugs” such as caffeine or alcohol. If you are smoking slowly and drinking coffee, you are jamming up your circuits. Moreover, if you are pushing yourself up, you will come down quickly. Your sugar will also come down. You may feel an energy low and feel compelled to eat more, especially food with high sugar content in order to get yourself going again. If you eat too much, you are at risk of gaining weight and getting Type II diabetes, especially if your family is prone to it.
In Carol’s case, she was using “legal” drugs and becoming addicted to them. It was hard for her to give up her chemical supports but she gradually weaned herself off them and talk therapy helped her address her underlying depression. Had her doctor not referred her, she would have gone on, spiralling downward. On the other hand, if she had started therapy earlier in life, she wouldn’t have had so many problems.
The lessons from all these examples are clear: if you are experiencing physical issues, go to your doctor and don’t rest until you know whether there are medical causes. Your doctor should know what the right medications are for you and will be able to advise you on exact dosages you need and when to take them. If you are experiencing psychological issues, go to your therapist and get the right diagnosis and treatment. Don’t let either physical or psychological distress trigger you to self-medicate. Don’t try to do it on your own. There are serious risks to self-medicating that can and will hurt you and your loved ones. You can solve these problems without drugs and by using the appropriate medications correctly.
By Richard Zimmer 04/24/14
Richard Zimmer is a regular contributor to The Fix. He last wrote about USDOT drug violations.