Wednesday, October 05, 2005

A well known secret

I have been a monomaniac for the last three years promoting the idea that most drug users are self medicating for undiagnosed conditions. A lot of PTSD, some bipolar, some ADD/ADHD etc. Below I have reprinted two reports from the field. One a drug counselor and another from a doctor.

Both point to the fact that a lot of problem drug users are self medicating. Clayton Cramer, with whom I have been having a most interesting private discussion, has brought up a number of interesting questions. The most important is this: he does not doubt that some chronic users may be self medicating (although which users and which conditions is still in contention), what he does believe, though, is that there might actually be a large number of recreational users to whom harm is being done (we will leave out the libertarian question of whether self inflicted harm is any of the governments business, except for the up coming war on food eaters). And with that question although I have my beliefs I have no proof.

Which brings up a most important question. Why don't we have better studies on this question? We are studying drugs deeply. Why aren't we studying drug users?


First what a drug counselor says:

From Winds of Change:

#3 from Guy Hall on April 26, 2003 03:08 AM

As a drug and alcohol counselor, I agree wholeheartedly with pain being the main cause of alcoholism and chemical dependency. PTSD is but an extreme example of the pain that alcoholics and drug addicts suffer. For many of my clients, abuse both phyisical and emotional was the means used to teach them destructive beliefs. The more "energy" used in the abuse, the more pain carried into adulthood.

Consequently, that results in more "energy" needed to overcome those beliefs.

Oh, and the one emotional pain that I see? Shame.....whether it be men or women, it is shame that routinely surfaces as the undelying pain being covered up with drugs/alcohol. Women who suffered incest speak more about the pain they felt when, after the deed was done, they got the look of scorn and disgust from their father.
And then this bit from a doctor commenting on a study I reviewed on Adolecent Drug Use.

Originally posted at Grand Rounds 29 Sept '05

The Grand Rounds for this week is up and they have been kind enough to comment on a recent post of mine More Vindication.
Power and Control shares a compelling review of research supporting the hypothesis that drug abuse is self medication for pain/anxiety. This is one of the self-evident "truths" that most of us accept without good science to back us up. Last week I suggested an antidepressant medication for a man who drinks heavily - smokes marijuana often, and uses cocaine to "keep stable." But he doesn't want to take a medication for fear it will alter his physiology. "Man - you ARE taking medications" I meekly suggest. He doesn't see it that way.
Cross Posted at Classical Values


Anonymous said...

he doesn't want to see it that way

Because - in my experience with bi-polar in particular - he wants desperately to preserve the illusion that he is in control of his disease and his symptoms. He can kid himself that using alcohol or pot or whatever isn't really medicating himself and that he can stop at any time ....

Underneath that is usually a huge amount of fear and shame, along the lines of "if I admit I have this problem, I will end up admitting my life is out of control and I'm 'crazy'."

Yoyoing between 'I have no real problem, just some behavior I can change' and 'I can't be trusted to get better with doctor help'.

Anonymous said...

The catch-22 is that self-medication is usually extremely destructive for such people - not only an it flip brain chemistry in bad ways that are often irreversible, it also reinforces all the counter-productive beliefs and fears of people with learning and mood disorders.

Many end up becoming far worse off than they would otherwise. And pace libertarian emphasis on freedom, they are NOT choosing freeing when they make this decision ... it is the disordered brain chemistry making that choice.

M. Simon said...

Anon. Thu Oct 13, 12:57:40 PM 2005,

Says that it is dangerous for folks to self medicate because that makes the problem worse.

So how does a doctor treat the problem. He asks the patient questions. Gets a history and prescribes the latest and greatest (according to the ads) from big pharma. He tells the patient to take the drugs on such and such a schedule, for so long, and then come back for an evaluation.

Then he asks how did it work? What are the side effects? Want to try something else? Very good.

Now how is that any different (aside from the consult) of what people do when they self medicate? They try drugs. See if they work to reduce the mood swings or make them tolerable and if not or the side effects are too much they try something else.

My bottom line is not that these folks shouldn't get better help and better drugs if that is what is needed.

My bottom line is that we should not be putting them in jail.

Mahndisa S. Rigmaiden said...

10 17 05

Thx for the visit. I don't know how you found my blog; but I appreciate the comment. Good post; the complexities are evident. Anonymous has fallen for that B.S. psychobabble orthodoxy. The bottom line is that the vast majority of those who have been prescribed psycho drugs don't need them; they need some life coaching and some discipline. How do I know this? Gee I dunno, I was sexually assaulted TWICE since I began college. For seven years, they gave me every psycho drug known to man and I was in therapy. WHAT ever did the drugs do to help me? Numbed my brain so much that I couldn't even do a basic physics problem... I can't deny that they helped for a short term (60-90 days) or so but after that, OMG your brain cells deteriorate far more rapidly than if you smoked a bowl of pot. I am serious about this! Until we have better mechanisms to detect changes in brain chemistry and blood hormone levels etc; those using these drugs are simply guinea pigs. Some are helped, most are hindered and go into a dependent spiral with the psychiatric community. Not long ago (two years) they told me that I had sever Bi Polar and that I could get money from the government for being a nut job. Well, after taking some time off and living with family-seeking another rougue therapist; I realized that they were wrong! I saw three different psychiatrists and two felt that I had PTSD the one felt that I had bipolar. Screw these people! I don't take handouts and have been working for a year and a half. THe last specialist I saw felt as if the bipolar diagnosis was Wholy incorrect and that the sexual trauma caused my issues. Well, I am employed, going to school and married now, so I proved those jerks wrong! I hope anyone who reads this will get off the plantation called the mental health system. The only folks I know who have healed from trauma have done so. BTW sorry for writing so much; I was perturbed at the subject. And you are right; rather than jail more programmes and ALTERNATIVES shd be available...

Mahndisa S. Rigmaiden said...

10 17 05

BTW: An article published that showed that that pot benefits those with PTSD and in some cases, even schizophrenia. See the links below:

M. Simon said...

I'm reposting the above urls from Mahndisa S. Rigmaiden in clickable form:






M. Simon said...

And of course I have a few things to say about pot and PTSD too!

A test for PTSD

PTSD Pot Alcohol & Substance Abuse

Police and PTSD

Cannabis is the Best Medicine

Addiction or Self Medication?

M. Simon said...

It is interesting that our Mahndisa S. Rigmaiden was diagnosed with bipolar, then PTSD.

I think they are the same thing. Just a hunch.

Anonymous said...

PTSD and bi-polar are NOT the same thing, the effective treatments differ substantially for most people.

That said, it's also important to keep in mind the Bi-polar I vs. Bi-polar-II distinction, as the brain chemistry differences are significant, especially with regard to dopamine vs. seratonin receptors.

Mahndisa S. Rigmaiden said...

10 18 05

Hello M. Simon:
Thx for hooking up the links in clickable form. I will add you to my blogroll. This is because of the diversity of topics for which I have interest(s), as well as the scope of breadth of your blog:) Anonymous hasn't countered the point I made earlier about brain chemistry. To my knowledge there aren't too many ways neurotransmitters can be measured en vivo. I know that PET scans have shown promise, but this technology is still in its infancy regarding psychiatric diagnoses. Furthermore, self reporting always skews data, especially with those who are mentally disturbed. So the very method in which data is collected is flawed. Until we can be absolutely sure which neurotransmitters are off kilter, people who take these drugs are guinea pigs! I know a woman who was diagnosed years ago with "Manic Depression", now known as bipolar disorder. She has been on Lithium for over twenty years. She is forty and looks eighty. Her liver is failing and she has numerous health problems from all the years of ingesting Lithium. When I was ill, they gave me Depakote. This damn near tore out the lining of my stomach and caused serious mental dullness. I later found out that had I gotten pregnant, my child could have had birth defects (e.g. spina bifada). Of course, they NEVER EVER told me that; they were content to keep me in therapy and dope me up. I think a new approach is needed in the mental health world. Because therapy is a double edged sword. It can benefit if done properly, but more often then not, people who begin therapy never end therapy! Every time you heal from one wound, they go after another "pathology" to treat. Pharmaceutical companies LOVE shrinks! They keep people medicated and submissive. Sorry for typing so much again; this just tans my hide!

Mahndisa S. Rigmaiden said...

10 18 05

Oops, one more thing; Bipolars and PTSD patients DO have a lot of cross over in symptoms. Anxiety, depression, restlessness, insomnia and periods of intense disturbance are all hallmarks of both conditions. However, M. Simon makes a point that they could be two sides of the same coin. Apparently with me it was. I don't take any medication now and haven't for two years. I am doing just fine. The best thing therapy ever did for me was realize that the therapists are in no condition to tell me what to do with my life; I can make my OWN life decisions. But if you don't take that responsibility, they will try to make them for you.

M. Simon said...

I find it interesting that pot can be used to treat ADD/ADHD, bi-polar, and PTSD.

This would tend to indicate a commonality of CB receptors.

BTW lithium, touted as a wonder drug for bi-polar, is a very dangerous drug. The lethal dose is very near the effective dose. If pot worked for some of these folks it would be a big improvement since there is no effective lethal dose. Certainly not in the range of viable human consumption via smoking.


I would like to learn more about the differences between bi-polar and PTSD. As far as I can tell PTSD has been localized to the amygdala. Is there a similar localization re: bi-polar?

M. Simon said...


You might find this study of interest.

It touches on fear memories and mice. What it shows is that for some genetically bread mice fear memories decay slowly.

If your problem was PTSD then its disappearance over time is a normal factor in some cases.

In those cases you medicate until medication is not needed.

With diagnosis so confused, it shows the sad state of brain medicine compared to the front put up by doctors.

With A test for PTSD coming in a few years things should start to improve.

ShrinkWrapped said...

Thanks for sending me the link to this article. You are addressing an exceptionally complex area of behavior. It is certainly worth many blog posts to try to tease out the different factors involved. I have no doubt that many people begin to use various drugs, and then continue to use the drugs, because it makes them feel better. They may be unhappy because of life circumstances, characterological issues, or diagnosable psychiatric disorders (affective instability related to bipolar disorders, PTSD, borderline personality states prominent among them). However, once drug use has become habitual and/or addictive, the person's brain chemistry has been disordered in such a way that they now have a new drive derivative which controls their behavior and limits their psychological and behavioral freedom. Once they have reached this point, there is minimal chance that a psychiatric or psychological treatment can work without first addressing the substance abuse/dependence.
I would also separate the question of criminalizing drug users from criminalizing drug dealers. If you support your habit by selling your possessions or are a functional abuser/user who is able to work, then the only one you are harming is yourself and your family. (The question of how to address parents whose children are the innocent victims of their drug use is a more complicated societal question.) However, if you are dealing, even on the street level, you are spreading substances which can destroy people and should be treated accordingly.
That being said, our criminal laws do not do a very good job of differentiating the most harmful drugs from the less harmful. Crack is very addictive and should be taken very seriously; MJ is much less harmful and should be handled differently (and in many states that is already happening.)
I would also caution against generalizing from single instances. I have seen people who have broken serious drug and/or alcohol abuse patterns with minimal psychotropic medications and others who no amount of medicine is going to help. Each needs to be evaluated as an individual; sadly, with the current state of Psychiatric and substance abuse treatment, the treatment techniques and drug armamentarium are really quite limited and are blunt instruments, as well.

ShrinkWrapped said...

As an addendum, there is some evidence that the current treatment of trauma victims (which pushes for rapid recall of the events) may do more harm than good. By doing so, we may in fact be helping to consolidate the traumatic memory (and making the development of PTSD more likely.) A better approach might be to offer a drug that interferes with memory consolidation (beta-blockers for instance, which would leave the memory intact but diminish the affective valence of the event in question), which could decrease the likelihood of developing PTSD. The ethical issues invovled are significant, however.

M. Simon said...

Shrink Wrapped,

Thanks for dropping by to comment.

I think that your point about brain chemistry becoming disordered by drugs fails on the proof test.

All we have is brain studies of drug users compared to normals. This is no proof at all since it is possible that the brain abnormalities preceeded drug use. What is needed is a cohort study. It would have to be large because chronic drug use only affects about 5% of the population (if government figures are to be believed). Which means if you want 100 drug users you will need to follow at least 2,000. Probably more like 3,000. Each would need a series of PET scans, MRIs, and other tests every few years. This would cost in the 10s of millions over the life of the test. We will not get something like that out of NIMH or any private organization until there is significant demand or a wholesale discrediting of the studies the government currently touts.

Criminalizing supply while legalizing demand is just another way to keep police busy. Think economics. As long as you have demand there will always be supply at a price.

I have heard this argument before. It makes no economic sense.

Which points to the fact that the mere mention of drugs leads to all kinds of magical thinking on the part of those who oppose drugs (proponents of course have their own magical thinking defects - like the "every one should take LSD" craze of the late 60s.)

As to PTSD treatment via early drug intervention: the Israeli Army is trying out the administration of THC pills. This seems promising as we know that the amygdala is the seat of these memories and cannabinoids home in on them in the amygdala.

My - Wed Oct 19, 12:03:28 AM 2005 - post in these comments has two links the first to a study of pain/fear memories in mice and cannabinoid receptors (I also sent it by e-mail to you). The second is about a PTSD test being developed by the Israelis in conjunction with some American hospitals.

I think your point about the sad state of knowledge in the practice of mental health interventions rings too true. This is not bad (ignorance while no virtue is not a crime either)except for the fact that practioners over promise in an area in which they are basically flying blind without instruments.

Fortunately our days of ignorance are coming to an end.

Ren said...

Hey, thanks for dropping over by the hypergraphic blog. I just wanted to let you know that I am not going to argue any of this with you. Yes, I'm the biological sciences and don't know anything, as you say. I only speak of experience. And we both know therein lies the difference between knowledge... and wisdom.

Anonymous said...

I have pondered tirelessly over the last several years, well, since Sept. of 2001 to be exact, over what causes a liberal's brain to function as it does (or to be more specific, 'malfunction'). I haven't been able to understand how a normal looking and acting human being, can be so adamant about taking such a negative attitude toward their country that they won't let themselves be affected or influenced by facts. I see them take joy in destroying the country that is their own and get excited when they can say something negative about it or it's present administration, irrelevant to whether it be true or not. I think I have narrowed a lot of it down to mind altering drug use. At this time, there appears to be no legal cure, since reasoning and facts only make their eyes roll back in their head and ignites their pre-written, undebateable rants. The only cure I've seen work so far, which actually cures 'everything' (including cancer) that is ailing a liberal, is depravation of oxygen, for a minimum of 10 minutes.

I'm not a doctor, but I did stay at Holiday Inn Express last night.