Published on November 10, 2014 by Shahram Heshmat, Ph.D. in Science of ChoiceWhat purpose drugs might be serving in the lives of addicts? The short answer is: they are painkillers for treating psychological pain, at least in the short term. Addiction is both a solution and consequence of the psychological pains. Theories of addiction help us better understand the motivations for drug use. The self-medication theory of addiction suggests that individuals with deficits in emotion-regulation skills (i.e., skills relevant for modifying emotional reactions and to tolerate negative emotions) use drugs in an attempt to manage negative or distressing affective states. For instance, individuals with histories of exposure to adverse childhood environments (e.g., physical and sexual abuse) tend to have diminished capacity to regulate negative emotions and cope effectively with stress. This view of addiction emphasizes that psychological pain is at the heart of addictive behavior and that vulnerable individuals resort to their addiction because they discover that the addictive substance or behavior gives short-term relief and comfort from their distress. Drugs are more appealing for those who have suffered major traumatic experiences. In other words, addiction problems are less about pleasure seeking behavior than they are about human psychological pain and deficits in internal sources of self-soothing. In the initial stage of addiction, drug use can successfully lead to reductions in the negative affect. In low to moderate doses, depressants (alcohol) can relieve states of anxiety or tension associated with depression. But, in the longer period, chronic use contributes to neurobiological changes in the brain. These changes may underlie the transition from the use motivated primarily for achieving a high or relief to use that is motivated for regaining a sense of normalcy. The end result of such a process is that the individual begins to engage in compulsive drug use. They are no longer in volitional control of their drug use. For those with a penchant to suffer a range of psychiatric disorders (depression or anxiety), repeated uses of drug become a way of life. Relief is momentary, but in the long-term drug use becomes an end in itself. The addiction problem prevents the user from understanding about her distress, as well as the development of emotional capacity to self-soothe. In essence, addicts substitute a misery that is vague and confusing with a misery that is caused by a drug use. The theory of self-medication emphasizes that addictive drugs are not equally appealing. Although a person might experiment with various drugs, they discover that they are drawn toward a certain drug (e.g., stimulants, depressants) because of what it does for them. For example, many cocaine abusers attempt to regulate inner emptiness, boredom, and fight depression. Stimulants help to overcome feelings of low energy fatigue, and low self-esteem problems associated with depression. Alcohol is frequently used as a way of coping with social anxiety. The drinking removes, at least temporarily, the stress of anxiety. Thus, the drug of choice reveals psychological problems that are painful for that person. A study that followed over 1200 children from birth found that individuals with depression in adolescence were at significantly greater risk of later developing nicotine dependence. Using nicotine relives the distress of major depression and less severe depressive symptoms. On a large scale, when communism collapsed, alcohol drinking increased significantly in Russia. About 25% of Russian men die before age 55 mostly due to the alcohol use, particularly vodka. Causes of death include liver disease and alcohol poisoning, and aggressive behavior. The sense of hopelessness in concerning self and future life increased alcohol use to cope with emotional distress. The self-medication theory of addiction provides a useful tool for the understanding and treatment of addiction. This theory explains that addiction develop in context. That is, the psychological distress and suffering increases addictive vulnerability. In the short-term, they can better endure their distress and cope with the realities that can otherwise feel so unbearable. This theory provides a humanistic psychological understanding for addictive behavior, one which sees people with addiction as a fundamentally vulnerable population. Effective treatment, like self-medication theory, is based on the implied notion that the intention of drug use is not pleasure, but to find a relief from unendurable suffering and pain in the absence of alternatives.