Self-Medicating Harm Reduction: Tips for Safer Self-Medication

A lot of the people I treat for depression, anxiety, and stress management tell me that they’re becoming concerned about their use of “drugs, alcohol, pot, and cigarettes.” All of these are drugs and yet they’re distinct categorically in the mind of the user. They represent very different threats to the individual. It’s telling that the order in which they’re presented is consistently the order in which they do the most amount of damage in the least amount of time.

Assessing the Situation

When the subject of self-medication comes up, rather than give an opinion on whether someone may be developing a pattern of abuse or addiction; I encourage folks to do some self screening:

• Do you tend to take things to extremes/have an addictive personality?
• Are you depending on a substance to cope with stress and/or negative emotions?
• Do you tend to make high risk choices while under the influence?
• Do you have a family history of alcoholism or addiction?

The next issue to consider is willingness. For those who are unwilling to explore life without substances, I advocate minimizing potential harm. In simple terms, what are we willing to do to reduce risk?

Understanding Harm Reduction

Harm reduction can be conceptualized as removing vices in the order in which they make life most unmanageable.

Self medicating is based in the belief/experience that dealing with life without substances and established forms of coping (no matter how unhealthy) is either undesirable or impossible.

The intersections of harm reduction and self medicating have not been meaningfully explored as combined approaches.

Self-Medication - Addiction and Other Risks

We’re still ignoring the progression of self medication, experimentation, and substances that carry high risks when abused:

“Soda pop and Ritalin…
alcohol and cigarettes
and mary jane to keep me insane,
doing someone else’s cocaine.” 

- Green Day “Jesus of Suburbia”

Taking Stock of What We Use & Why

If we want to lower our risks, we must recognize that morality and legalities do not belong in the criteria of what’s safe (body and mind) and what isn’t. Alcohol is completely legal for those over 21 and it not only kills people every day, it’s also amongst our most abused and addictive substance.

If we’re going to make changes to our drug use, we need to stop using categorical approaches like “meds”, “drugs”, “drinking” or “smoking.” These distinctions are arbitrary and make it far easier to rationalize why it’s okay to continue using them. Look at each of the substances as what they are – chemically mood altering substances.

Be brutally honest:

Pros:

• What’s the overall effect of the drug?
• What do I enjoy most about using it?
• What do I gain from the use?

Cons/Risks:

• Is the substance addictive?
• What are the possible drug interactions and side effects?
• How is impulsivity, decision making and regulation of emotion and behavior affected?
• Does the drug have the potential to kill (overdose, poisoning)

Self-Medicating without Substances

Instead of simply considering what to eliminate or reduce (which leads to a feeling of denying ourselves) we can also consider what to add. Seeking outlets for stress and negative emotion can be combined with activities and pursuits we enjoy. If we want a safe chemical to use; we’re free to try adrenaline. Skydiving is comparable to stimulant use at about the same cost and with far fewer (statistical) risks.

Choosing the Lesser of Evils

When we are completely honest with ourselves, we know that using any mood altering substance involves ingesting toxins and compromising our health. Measuring the pros and cons gives us a clear view of what we’re seeking and how it can be attained with the least amount of harm. In the grand scheme of things, nicotine, caffeine, and marijuana are as close as we can come to safety without abstinence.

Marijuana?

I recognize that for some folks, abstinence from Marijuana is not a choice that they’re willing to make. In these cases, while I don’t recommend using cannabis, I see that it is far less dangerous than using alcohol or other drugs.

The real challenge in using marijuana is that once we’ve medicated or used recreationally, the temptation becomes stronger for some to then ingest another substance to heighten the experience. However, this dynamic is far more common with alcohol due to the impact on our inhibitions. The best approach is to make these decisions before using pot and resisting any temptations that may arise afterwards.

Building a Satisfying Life

The greatest opportunity is to invest in not only the emotional health we want, but in our lives holistically. We all know that drugs simply offer instant gratification. The challenge is to consider what would be far more gratifying in the long term. To work toward these ends is the most important piece of achieving emotional maturity and ultimately toward having the life we most want.