“Almost every aspect of human life has become drugified in some way: made more reinforcing, more accessible, more abundant, more novel, more potent, such that it’s now possible to get ‘addicted’ to almost anything,” Dr. Lembke says. Anecdotally, she says, “we are seeing that more and more. We see people addicted to Candy Crush, people addicted to Instagram, people addicted to League of Legends, people addicted to cupcakes.”
In short, self-medicating doesn’t only look like ripping shots because you feel stressed or bummed. It’s important to keep an eye out for all the different forms it might take.
What are the warning signs that you might be self-medicating?
A major red flag to look out for: You’re using drugs or alcohol (or anything else listed above, really) to change the way you feel or to, in some way, escape your current reality. For example: “I’m depressed or I can’t sleep, so I’m going to drink a pint or drink some wine,” Dr. Lembke says. “Or I’m anxious: I’m going to smoke because I’m overwhelmed.”
From there, you might find that you’re no longer doing some of the things that once made you feel good, and turning straight to your substance of choice instead. Maybe you’re spending less time with—or even actively avoiding—your friends and family. Maybe you’re ditching some of your hobbies: say, canceling your regular tennis match with a buddy. Maybe you’re becoming secretive about how you’re spending your time, or choosing not to answer when a loved one checks in to ask what you’ve been up to. You may even stop taking care of yourself—eating regularly, prioritizing sleep, showering daily, brushing your teeth, cleaning your room, doing your laundry—as much as you used to.
Another indicator: You find that it takes bigger and bigger doses of your preferred substance to help you feel better—and that, ultimately, you wind up feeling worse. “The development of tolerance, needing more of that drug over time to get the same effect, would be a warning sign,” Dr. Lembke says. “[Another] warning sign would be for people to look at not just the way they feel when they’re using, but how they feel afterward. Using, in that moment, seemed to alleviate your depression or anxiety. But how did you feel the next day? Was your mood even worse?”
Self-medicating can feel like it’s working—but that’s only an “illusion of efficacy,” Dr. Lembke says. At some point, it’s going to backfire. “A substance that initially relieves anxiety, depression, inattention, insomnia, whatever it is, it will eventually stop working,” she explains. “It turns on them and makes them anxious, makes them unable to sleep, makes them paranoid. And by then, they’re hooked. So even though it’s not working and, in fact, making the underlying problem worse, they’re now in this state of physiologic dependence and [have a risk of] withdrawal that makes it very difficult to quit.”
Self-medicating can develop into a full-on substance use disorder, Dr. Brewer says, which can put you in a tough spot. “It could be causing problems socially. It could be causing problems interpersonally with family. It could be causing problems with work,” Dr. Brewer says. “On top of that, these can feed on each other. I see a lot of patients who have anxiety who drink, and then they wake up in the morning and they have a hangover, which makes them more anxious.”