7 ms·

Over the last few years, due to personal events in my life, I've been thinking a lot about the relationship between drug addiction and emotional pain. Self-medi

by md224 9y ago

Over the last few years, due to personal events in my life, I've been thinking a lot about the relationship between drug addiction and emotional pain. Self-medication is a huge factor in drug use, and I hope everyone understands that. From the perspective of self-medication, drug addiction itself isn't the disease: drugs are just a coping mechanism to protect the user from a deeper agony. So when we talk about "reducing demand", we're not going to get anywhere unless we're able to provide people with better ways of dealing with their pain. A stint in detox isn't going to do shit for someone with depression or PTSD besides making them feel guilty and pathetic when they inevitably relapse. And if you actually succeed in making it impossible for this person to get their hands on illegal drugs -- while doing nothing to address their underlying pain -- then you might just end up with a suicide. As strange as it sounds, "drugs of abuse" may actually be the only thing keeping some people alive. In a way, our current drug epidemic is partially a failure of psychiatry. We need to do better in terms of addressing these root causes of psychic anguish. Drug addicts aren't lazy hedonists; they're just people who want relief from their demons. They deserve better options.

mythrwy 9y ago
Why do people think pain is evil though? Perhaps the pain doesn't need to go away. Perhaps it's there for a reason. Perhaps attitudes need to change. Perhaps embracing and examining pain (within reason) should be a more common reaction. Just throwing out ideas. Slap 'em if you want to. But I will note not every society has needed to use so many pain relievers.
- taeric 9y ago
  Often the folks experiencing this pain are experiencing the kinda of pain you probably can't really imagine till it hits you once or twice. I used to have questions on migraines. Then I had the kind where you go blind for a bit before the headache. Yes, it is more painful than any normal headache. In a sense, this is like asking why do we treat allergies? Maybe the body is reacting that way for a reason, after all.
  - mythrwy 9y ago
    Understood and agreed. Within reason. But also often people's first response to pain at whatever level is to try to kill it without first trying to understand it. Pain is incentive to change what is happening. We need it. Otherwise we wind up even worse off.
    - Clubber 9y ago
      >But also often people's first response to pain at whatever level is to try to kill it without first trying to understand it. I think that's an invalid assumption. I don't like going to the doctor and I usually won't unless something really hurts. I don't know many people who enjoy doctor visits. I suspect it's inline with dentist visits.
      - hycaria 9y ago
        I can assure you, your behavior is not universal in that domain.
    - taeric 9y ago
      Agreed, also within reason. :) I do note that opioids seem to be a particularly bad form of pain medication. You may start them to just fight some pain, but there are good chances you will get addicted. So, often it started to manage truly high levels of pain, but continues past necessity. Similarly to most recreational risk taking of any kind. Social natures will move people beyond most risk heavy habits. This includes drugs. Addiction does exist, but it is not as simple as "this person is addicted."
- zkms 9y ago
  > Perhaps the pain doesn't need to go away. Perhaps it's there for a reason. Pain is indeed useful most of the time (to prevent damage to the organism) but like all warning systems, it has false positives or activates when the cause of activation cannot realistically be remediated. Those are the cases where opioid or cannabinoid medication can be useful; because having protective mechanisms like pain activated chronically and for no good reason can be debilitating.
- Clubber 9y ago
  >But I will note not every society has needed to use so many pain relievers. Vaccinations either, but the child mortality rates used to be a lot higher than they are today.
- md224 9y ago
  I'm actually glad you posted this response, because it's a topic that needs to be addressed. I recently watched a video of a Columbine survivor giving a TED talk about emotional pain and addiction, and he said something along the lines of: "If you want to heal it, you have to feel it." Basically this commonsense idea that the best way to heal from trauma is to face it. It sounds right... but is it? The guy giving the talk had been addicted to opioids for 10 years before getting sober and confronting his emotional pain. The implication is that he could've saved himself 10 years of drug addiction if he had just confronted his pain after the shooting instead of medicating it. However, he doesn't seem to consider the possibility that he might've been unable to process his pain immediately after the shooting, and that he was only able to overcome his trauma after a certain amount of distance (time-wise) from the incident. So this is the question: is it always the right move to confront one's emotional pain in full? Is there ever a circumstance where numbing pain via medication (at least temporarily) could lead to better outcomes? I don't know the answers. I'd love to know if there have been scientific studies done on this issue... I actually asked this question on /r/AskScience a month or two ago but it didn't get much attention. Curious to see what the research says.
  - 55555 9y ago
    This is only partially relevant, but I know from personal experience that sometimes facing the pain is the wrong choice, at least in regards to anxiety attacks and CBT. It's simply not necessary at all and can be very counter-productive.
    - bonesss 9y ago
      Yeah. Generalizing, naturally, but "exposure therapy" is an approach of getting people past phobias and trauma that involves lots of small steps in controlled environments, and it's not recommended in all cases or for all conditions. I think it's also a bit simplistic when we frame avoidance solely as a product of being unwilling to face pain. In some cases (certain forms of PTSD), substance abuse is used to numb because you've exceeded your local tolerance for the pain you've been facing, or because the only thing you've been experiencing/facing is pain and its exhausted your coping mechanisms. Learning at mid-life that you're no longer the person you knew, while also dealing with the traumatic source, compounds the process of processing the events. Particularly when getting into how life altering traumas work, coping and accepting are processes that require different treatments/approaches at different times.
- gambiting 9y ago
  If you have terminal cancer, then the pain is not going to go away until you die. Yes, it's there for a reason, but in a lot of cases powerful pain relievers are the only real option to make someone's last months slightly more comfortable.
  - hycaria 9y ago
    If you have terminal cancer, it's not a big deal to get hooked on opiates as your life is basically over anyways and will not last long.
    - gambiting 9y ago
      Which is exactly my point. By making it more difficult to obtain painkillers, because "pain is natural", people who are terminal and need them to maintain at least a bit of humanity at the end of their lives might find it difficult to get the pain management they need. It's already an issue where anything opioid-based is extremely strictly regulated(for example - in Egypt, it's super difficult for doctors to administer morphine, which means that people who really need it might have to go without appropriate painkillers).
- pjc50 9y ago
  > not every society has needed to use so many pain relievers Medicine used to do major surgery without anesthetic. It's not a world people would want to go back to. There might be some mileage in a more integrated pain clinic approach to some kinds of milder chronic pain which could benefit from physiotherapy. But in the American context, what matters is what people can get on insurance (if any), not what's best for them.
- NoGravitas 9y ago
  Pain is always evil, or the word "evil" has no meaning. BUT.... "And since pleasure is our first and native good, for that reason we do not choose every pleasure whatsoever, but will often pass over many pleasures when a greater annoyance ensues from them. And often we consider pains superior to pleasures when submission to the pains for a long time brings us as a consequence a greater pleasure. While therefore all pleasure because it is naturally akin to us is good, not all pleasure is should be chosen, just as all pain is an evil and yet not all pain is to be shunned. It is, however, by measuring one against another, and by looking at the conveniences and inconveniences, that all these matters must be judged. Sometimes we treat the good as an evil, and the evil, on the contrary, as a good." (Epicurus, letter to Menoeceus)
  - DoofusOfDeath 9y ago
    > Pain is always evil, or the word "evil" has no meaning. What about pain that teaches us to avoid harm? E.g., the pain from touching a hot stove?
    - NoGravitas 9y ago
      I think the quote covers that.
- Bartweiss 9y ago
  > I will note not every society has needed to use so many pain relievers. People are rightly pointing out that most societies didn't have the option, but I think you have a point even so. My objection would be that other societies don't seem to have avoided painkillers by embracing pain; they seem to have actually felt less of it. Average health in the US is not good. Chronic ailments like inflammation, joint damage, and RSI are quite common, and even ostensibly healthy people are quite likely to report frequent pain or pain at work. So I think it's true that our reliance on painkillers is an error in how we relate to pain, but I disagree that the answer is accepting pain. Rather, the mistake is in using painkillers as a way to mask issues with overall health. Fixing that is hardly easy, and I don't think opposing painkillers is the way to make it happen, but it is important.
slfnflctd 9y ago
> "drugs of abuse" may actually be the only thing keeping some people alive First hand, I can tell you this is true. I may not always be taking something, but if I am, I'm pretty sure it's better than being dead. Which is an alternative I have both considered and pursued in the past. Whatever you may think of me for it, I mean it. The vast majority of my experiences with mental health professionals - particularly psychiatrists - have left me almost pitying their dearth of comprehensively effective models or tools. Talk therapy usually went better for me, but it's the wild west and the luck of the draw there, too. Addressing the root causes is the hardest work, because it encompasses everything-- relationships, finances, ethics, traumas, personal development (or the lack thereof) and on & on, all tangled together in a spaghetti mess. Sometimes staying where you are for a while is safer, at least until you find more stability or better therapeutic options.
wastewaste 9y ago
> besides making them feel guilty and pathetic when they relapse I don't see how a bit of time to reflect and cope in a careful environment is strictly a bad thing. You reinforce a stereotype that is not helpful to those to whom it really applies, because it implies a inevitability, which hopefully, is not actual.

by md224 9y ago

mythrwy 9y ago

Why do people think pain is evil though? Perhaps the pain doesn't need to go away. Perhaps it's there for a reason. Perhaps attitudes need to change. Perhaps embracing and examining pain (within reason) should be a more common reaction. Just throwing out ideas. Slap 'em if you want to. But I will note not every society has needed to use so many pain relievers.

taeric 9y ago
Often the folks experiencing this pain are experiencing the kinda of pain you probably can't really imagine till it hits you once or twice. I used to have questions on migraines. Then I had the kind where you go blind for a bit before the headache. Yes, it is more painful than any normal headache. In a sense, this is like asking why do we treat allergies? Maybe the body is reacting that way for a reason, after all.
- mythrwy 9y ago
  Understood and agreed. Within reason. But also often people's first response to pain at whatever level is to try to kill it without first trying to understand it. Pain is incentive to change what is happening. We need it. Otherwise we wind up even worse off.
  - Clubber 9y ago
    >But also often people's first response to pain at whatever level is to try to kill it without first trying to understand it. I think that's an invalid assumption. I don't like going to the doctor and I usually won't unless something really hurts. I don't know many people who enjoy doctor visits. I suspect it's inline with dentist visits.
    - hycaria 9y ago
      I can assure you, your behavior is not universal in that domain.
  - taeric 9y ago
    Agreed, also within reason. :) I do note that opioids seem to be a particularly bad form of pain medication. You may start them to just fight some pain, but there are good chances you will get addicted. So, often it started to manage truly high levels of pain, but continues past necessity. Similarly to most recreational risk taking of any kind. Social natures will move people beyond most risk heavy habits. This includes drugs. Addiction does exist, but it is not as simple as "this person is addicted."
zkms 9y ago
> Perhaps the pain doesn't need to go away. Perhaps it's there for a reason. Pain is indeed useful most of the time (to prevent damage to the organism) but like all warning systems, it has false positives or activates when the cause of activation cannot realistically be remediated. Those are the cases where opioid or cannabinoid medication can be useful; because having protective mechanisms like pain activated chronically and for no good reason can be debilitating.
Clubber 9y ago
>But I will note not every society has needed to use so many pain relievers. Vaccinations either, but the child mortality rates used to be a lot higher than they are today.
md224 9y ago
I'm actually glad you posted this response, because it's a topic that needs to be addressed. I recently watched a video of a Columbine survivor giving a TED talk about emotional pain and addiction, and he said something along the lines of: "If you want to heal it, you have to feel it." Basically this commonsense idea that the best way to heal from trauma is to face it. It sounds right... but is it? The guy giving the talk had been addicted to opioids for 10 years before getting sober and confronting his emotional pain. The implication is that he could've saved himself 10 years of drug addiction if he had just confronted his pain after the shooting instead of medicating it. However, he doesn't seem to consider the possibility that he might've been unable to process his pain immediately after the shooting, and that he was only able to overcome his trauma after a certain amount of distance (time-wise) from the incident. So this is the question: is it always the right move to confront one's emotional pain in full? Is there ever a circumstance where numbing pain via medication (at least temporarily) could lead to better outcomes? I don't know the answers. I'd love to know if there have been scientific studies done on this issue... I actually asked this question on /r/AskScience a month or two ago but it didn't get much attention. Curious to see what the research says.
- 55555 9y ago
  This is only partially relevant, but I know from personal experience that sometimes facing the pain is the wrong choice, at least in regards to anxiety attacks and CBT. It's simply not necessary at all and can be very counter-productive.
  - bonesss 9y ago
    Yeah. Generalizing, naturally, but "exposure therapy" is an approach of getting people past phobias and trauma that involves lots of small steps in controlled environments, and it's not recommended in all cases or for all conditions. I think it's also a bit simplistic when we frame avoidance solely as a product of being unwilling to face pain. In some cases (certain forms of PTSD), substance abuse is used to numb because you've exceeded your local tolerance for the pain you've been facing, or because the only thing you've been experiencing/facing is pain and its exhausted your coping mechanisms. Learning at mid-life that you're no longer the person you knew, while also dealing with the traumatic source, compounds the process of processing the events. Particularly when getting into how life altering traumas work, coping and accepting are processes that require different treatments/approaches at different times.
gambiting 9y ago
If you have terminal cancer, then the pain is not going to go away until you die. Yes, it's there for a reason, but in a lot of cases powerful pain relievers are the only real option to make someone's last months slightly more comfortable.
- hycaria 9y ago
  If you have terminal cancer, it's not a big deal to get hooked on opiates as your life is basically over anyways and will not last long.
  - gambiting 9y ago
    Which is exactly my point. By making it more difficult to obtain painkillers, because "pain is natural", people who are terminal and need them to maintain at least a bit of humanity at the end of their lives might find it difficult to get the pain management they need. It's already an issue where anything opioid-based is extremely strictly regulated(for example - in Egypt, it's super difficult for doctors to administer morphine, which means that people who really need it might have to go without appropriate painkillers).
pjc50 9y ago
> not every society has needed to use so many pain relievers Medicine used to do major surgery without anesthetic. It's not a world people would want to go back to. There might be some mileage in a more integrated pain clinic approach to some kinds of milder chronic pain which could benefit from physiotherapy. But in the American context, what matters is what people can get on insurance (if any), not what's best for them.
NoGravitas 9y ago
Pain is always evil, or the word "evil" has no meaning. BUT.... "And since pleasure is our first and native good, for that reason we do not choose every pleasure whatsoever, but will often pass over many pleasures when a greater annoyance ensues from them. And often we consider pains superior to pleasures when submission to the pains for a long time brings us as a consequence a greater pleasure. While therefore all pleasure because it is naturally akin to us is good, not all pleasure is should be chosen, just as all pain is an evil and yet not all pain is to be shunned. It is, however, by measuring one against another, and by looking at the conveniences and inconveniences, that all these matters must be judged. Sometimes we treat the good as an evil, and the evil, on the contrary, as a good." (Epicurus, letter to Menoeceus)
- DoofusOfDeath 9y ago
  > Pain is always evil, or the word "evil" has no meaning. What about pain that teaches us to avoid harm? E.g., the pain from touching a hot stove?
  - NoGravitas 9y ago
    I think the quote covers that.
Bartweiss 9y ago
> I will note not every society has needed to use so many pain relievers. People are rightly pointing out that most societies didn't have the option, but I think you have a point even so. My objection would be that other societies don't seem to have avoided painkillers by embracing pain; they seem to have actually felt less of it. Average health in the US is not good. Chronic ailments like inflammation, joint damage, and RSI are quite common, and even ostensibly healthy people are quite likely to report frequent pain or pain at work. So I think it's true that our reliance on painkillers is an error in how we relate to pain, but I disagree that the answer is accepting pain. Rather, the mistake is in using painkillers as a way to mask issues with overall health. Fixing that is hardly easy, and I don't think opposing painkillers is the way to make it happen, but it is important.

slfnflctd 9y ago

> "drugs of abuse" may actually be the only thing keeping some people alive First hand, I can tell you this is true. I may not always be taking something, but if I am, I'm pretty sure it's better than being dead. Which is an alternative I have both considered and pursued in the past. Whatever you may think of me for it, I mean it. The vast majority of my experiences with mental health professionals - particularly psychiatrists - have left me almost pitying their dearth of comprehensively effective models or tools. Talk therapy usually went better for me, but it's the wild west and the luck of the draw there, too. Addressing the root causes is the hardest work, because it encompasses everything-- relationships, finances, ethics, traumas, personal development (or the lack thereof) and on & on, all tangled together in a spaghetti mess. Sometimes staying where you are for a while is safer, at least until you find more stability or better therapeutic options.

wastewaste 9y ago

> besides making them feel guilty and pathetic when they relapse I don't see how a bit of time to reflect and cope in a careful environment is strictly a bad thing. You reinforce a stereotype that is not helpful to those to whom it really applies, because it implies a inevitability, which hopefully, is not actual.