Dr. Karoly: I am talking with Dr. Cory Newman. Dr. Newman – thanks for joining us.
Dr. Newman: My pleasure, glad to be here.
Dr. Karoly: When people are clinically depressed, they sometimes try to cope in ways that are not necessarily good for them. In your opinion, what is one of the most striking examples of a coping strategy that can actually be harmful to people who are depressed?
Dr. Newman: Excellent question. As your question implies, not all coping strategies are created equal. Some coping strategies are healthier than others, and unfortunately, some coping strategies are downright harmful. One such harmful coping strategy is something called “self-medication,” which refers to a person’s attempt to use alcohol, street drugs, or inappropriate controlled substances, such as pain killers, in order to feel better temporarily.
Dr. Karoly: Dr. Newman, can you spell out some of the hazards of engaging in self-medication? What can happen to people who engage in this faulty coping strategy?
Dr. Newman: Let’s look at alcohol use for starters. It’s well known in our society that people sometimes use alcohol to “drown their sorrows,” as the saying goes. Movies depict this all the time, and they often try to make it look pathetically funny, but really it’s no laughing matter. Although alcohol can feel like a welcome anesthetic at first, it is actually a central nervous system depressant. Thus, the ultimate effect of using alcohol when you are depressed is to feel even more depressed, especially if alcohol is used frequently and excessively. People get trapped in a pattern where they drink to “ease their pain,” then they feel worse, so they drink more, which makes them feel even worse, so they drink more, and so on and so on, until it becomes a serious problem, both in terms of the drinking itself and the depression, which gets worse.
Dr. Karoly: And how about the issue of people using inappropriate medications or street drugs in order to self-medicate?
Dr. Newman: It’s very similar to what I just described about alcohol use, only there are can be even more complications, because the inappropriate use of a controlled substance and the use of street drugs is also illegal, which can have its own awful consequences, and that’s just going to make people more depressed too. Further, the dangers of overdosing are significant, especially if these drugs are used along with alcohol. In fact, about half of all suicides (whether accidental or intentional), are related in some way to alcohol and other drug use. A depressed person who is not suicidal while sober might in fact, suddenly and impulsively decide to kill himself if he is in an altered state of mind owing to drug use. Similarly, a depressed person who believes that she does not have the gumption to kill herself while she is sober may decide that she can get into a deadlier state of mind if she drinks and uses drugs, because that way she won’t be thinking about the pain involved in the act of suicide, or about the future that will be lost, or about the horrible consequences for loved ones who she leaves behind. When depressed people are also chemically impaired, they are most certainly not in their right minds, and therefore their decisions can be traumatic and deadly.
Dr. Karoly: If self-medication is as harmful as you describe, why do people do it?
Dr. Newman: There are lots of reasons. First, self-medicating seems like the quick and easy thing to do to get instant results. For example, drinking a bottle of vodka to temporarily blot out your suffering because your wife just left you seems quicker and easier than dealing with the consequences of re-adjusting your life as a single person, and it also seems quicker and easier than making an appointment to start therapy and doing therapy. People by-in-large are very responsive to things that are quick and easy. We respond to immediate gratification. This is especially true if we feel depressed and we don’t believe that we can hang in there and cope for the long run. Unfortunately (as all too many lessons in life show us), the thing that is “quicker and easier,” often is not what is better. What
is better would be to do everything possible to maintain a clear-headed state of mind so that you can make good, sensible decisions that will improve your life. What is better is to engage in healthy things, such as spending time with supportive friends and family, exercising, engaging in work, school, hobbies, and committing to an appropriate course of professional treatment, whether it is therapy or medications or both.
Dr. Karoly: Well, Dr. Newman, since you mention “medication” as a treatment option, let me ask you this. How is taking prescribed medication for depression any different than engaging in self-medication? Aren’t they both examples of using chemicals to feel better? Why is one method okay and the other not?
Dr. Newman: I’m glad you brought that up, because all too many people have that same question, and it rarely gets discussed the way it should. So here goes, if a depressed person goes on a medication that is specifically prescribed for depression, in the context of that particular person’s medical condition and history, then that is not an example of self-medicating, because it is a well-targeted, individualized treatment that is supervised by a medical professional. Not only that, but most medication treatments for depression do not reduce the patient’s functioning capacities the way that alcohol and street drugs can. To the contrary, the proper medications can greatly improve a depressed person’s functioning, so that they can live a more normal life and be more effective in meeting their obligations as students, employees, parents, partners, and so on. Contrast that scenario with getting wasted (self-medicating), where the depressed person misses school and work, drinks the family paycheck, fails to remember to pick up the kids, gets pulled over by the police and charged with a DUI, and winds up in an ER or the county jail.
Dr. Karoly: What about cases where depressed people are on properly prescribed medications, and they use alcohol or other drugs? What happens in those cases?
Dr. Newman: Well, it is often the case when someone is on anti-depressant medication, they are instructed by their physicians not to drink (and, it goes without saying, not to use illicit drugs as well). Alcohol and other drugs, aside from their own potentially harmful effects, often interfere with the proper action of anti-depressants. Therefore, if you think about it, it is somewhat self-defeating to take an anti-depressant on the one hand, and then to drink a depressant like alcohol on the other. I have encountered patients who told me that they were going to go off of their anti-depressant medication because they thought it wasn’t working. My response – knowing that these particular people were also regular drinkers — was that they were getting rid of the wrong chemical. They should be going off the alcohol, and then they might have a chance to see what the anti-depressant medication could really do, without the interfering effects of the alcohol.
Dr. Karoly: So, if the proper treatments are not quick and easy, how are people who are deeply depressed supposed to hang in there and do the better thing, which is to wait longer periods of time for more appropriate treatments to kick in?
Dr. Newman: Fair question! There is no easy answer for this. The reality is that quick fixes for clinical depression are an illusion. Real improvement requires sustained changes in a full range of habits, such as thinking more constructively, getting the proper amount of sleep, eating healthy, exercising, doing meaningful activities, interacting with others, and adhering to proper treatment, such as cognitive-behavioral therapy and perhaps anti-depressant medication. Although this does take some time, the positive changes will be more solid, stable, and meaningful. That’s the best “medicine” so to speak, even though it takes some time.
Dr. Karoly: Thank you Dr. Newman.
Dr. Newman: Thank you.
Dr. Karoly: You have been listening to my conversation with Dr. Cory Newman. Dr. Newman is a Clinical Psychologist and Associate Professor of Psychology in the Department of Psychiatry at the University of Pennsylvania School of Medicine. He is also the Director of the Center for Cognitive Therapy.