Harm Reduction The fine line between self-medication and abuse

[TheAppleCore]

I was wondering about this the other day.

Certainly it's possible that certain types of people are capable of using addictive drugs to treat their own issues with anxiety or depression or Attention Deficit Disorder, or any of a number of psychological illnesses, in a controlled manner.

So, how do we draw the line between constructive self-medication, and purely destructive addiction? I'm sure that some degree of physical dependency is just a negative side-effect of many instances of effective self-medication. So can we necessarily tell an addict that he or she is engaged in self-destructive behavior? Can we necessarily make any moral judgment about the drug use of an addict? How does the addict himself distinguish which camp he belongs to?

 

[albastrux]

It's definitely a difficult thing to distinguish, self-medication and abuse... and to some degree, and depending on your definition of each term, they can possibly overlap.

Depending on which moral-camp one belongs to, one may definitely make a moral judgment about the drug use of a user or addict. That is also an individual thing depending on both the person doing the judging and the person being judged. Morality is not universal, which creates further difficulty with the question posed here.

Regarding an addict himself and distinguishing whether he is self-medicating or just abusing the drug depends on that individual as well. I think most addicts or users who truly believe they are self-medicating might not be able to distinguish between that and abuse... however, technically, if one is not using a drug "as prescribed," in the case of prescription drugs, or if one is using an illegal narcotic all together, i guess that technically is considered abuse also.

The question you posed is difficult and interesting and I think requires a lot of thought! I'm quite interested in this topic as well, and you really got me thinking. At any rate, I guess I gave my input but I really can't further speculate because it's such a gray area!

 

[burn out]

I don't know. I use heroin to deal with chronic pain. Sometimes I feel like I should quit it and just be tougher and deal with the pain. I don't know what the right thing to do is. Sometimes I also abuse it, as in take high amounts and nod out. WHen I am nodding I definitely feel like I am abusing the drug as opposed to using it as a medicine.

 

[xxsicknessxx]

I think it comes down to a few things. So long as you function in life then your ok. I don't care if you shoot herion or smoke pot or drink or are sober or DO rc's or take a anti depresent. Were all addicted to something or even somebody. We just often times don't relate the fact that we drink soda all day to the guy shooting herion.

If you drink so much coke your getting ulcers and your health is at risk, or you smoke and get cancer and are killing your lungs or you shoot ox and your veins are going... its all the same.

But if you drink soda and your fine, or you take ox and your fine, or if you smoke and you fine.. then your fine you don't have a problem.

A problem is a problem something is wrong.. get my meaning?
People get tied up in dirty drugs or what the drugs do to you, or if your high but really everything you take in effects you in someway shape or form and we can get addicted to anything and anything can cause us not to function you just have to be able see it.

 

[TheAppleCore]

But if you drink soda and your fine, or you take ox and your fine, or if you smoke and you fine.. then your fine you don't have a problem.

A problem is a problem something is wrong.. get my meaning?

Yes. But then, ALL soda drinking is a problem, and ALL drug usage is a problem. Because no matter how infrequently you drink soda or eat candy or smoke cigarettes or use drugs, you can't avoid negative side-effects from these activities. Even if you only take one puff of one cigarette in your lifetime, that puff is going to deposit a tiny layer of tar in your alveoli. Even if you only drink a single soda in your lifetime, that industrially manufactured corn-syrup saturated liquid is going to replace calories that would have come from real, nutritious food.

Although they may not be profound enough to be noticed, there are always negatives to drug use. Something's always "wrong" with using drugs. Does that mean that everyone that uses drugs has a problem?

 

[tocooperate]

It's definitely a difficult thing to distinguish, self-medication and abuse... and to some degree, and depending on your definition of each term, they can possibly overlap.

Depending on which moral-camp one belongs to, one may definitely make a moral judgment about the drug use of a user or addict. That is also an individual thing depending on both the person doing the judging and the person being judged. Morality is not universal, which creates further difficulty with the question posed here.

Regarding an addict himself and distinguishing whether he is self-medicating or just abusing the drug depends on that individual as well. I think most addicts or users who truly believe they are self-medicating might not be able to distinguish between that and abuse... however, technically, if one is not using a drug "as prescribed," in the case of prescription drugs, or if one is using an illegal narcotic all together, i guess that technically is considered abuse also.

The question you posed is difficult and interesting and I think requires a lot of thought! I'm quite interested in this topic as well, and you really got me thinking. At any rate, I guess I gave my input but I really can't further speculate because it's such a gray area!

i think i'm finally at the point where, after having been in both camps, the differences dont seem very distinct anymore. i cried my heart out for the first time not too long ago. ive come to understand that despite all rationalization for self-medication, there is a part of you that conceals the guilt in order to justify the entire thing. its so much more subconscious than i had ever imagined it could be, because i know my body needs it, but it's worthless to me if all im doing is questioning and regretting.

despite this realization, nothing has changed.

 

[Renz Envy]

It's the difference between using drugs to enhance your life.

And living to use drugs.

 

[thugpassion]

It's the difference between using drugs to enhance your life.

And living to use drugs.

Yeah, any one who can say yes they are only useing drugs to enhance their life and dosen't think that they live to drugs is looking at their drug use unrealalisticly. If you think drugs enhance your life then you are always looking forward to the next time you can use drugs. Its hard to walk that line and stay on one side. I can do it it for a while like not get any dope all week but when the weekend comes its on. Am I living to use drugs? I am defintintley looking forward to the next time I can.

 

[laCster]

they are the same things in my book. a drug user is a drug user; we are all in "it" for personal happiness. labeling something as self-medication is like a sugar-coating to make users feel better..

 

[Alex000]

Labels are never 100% right. Patients, users, abusers, addicts etc. Drugs are always involved though. If it is a problem, then it is, if not, then not so much.

 

[bliz62]

I agree with Renz...living to use, use to live. For a looonng time I was just using to get through pain...then once in awhile for fun...and now, it's all day everyday consuming my life as to when I'll get to use again. I sure don't think about soda in quite the same way, but PP that's a pretty good analogy. Every thing I like seems to have some sort of addictive component.

 

[Tchort]

labeling something as self-medication is like a sugar-coating to make users feel better..

But this assumes that taking drugs (any drug) is de facto 'wrong' or 'immoral' or 'bad' to begin with.

Over the years I'm quite tired of having to justify to other people what certain drugs add to my life. I find my ability to perform day to day tasks, not to mention things that I enjoy (travel, engaging in creative outlets, etc), is severely inhibited without or with reduced use or dosages of opioids. So the alternative is clear; take the opioids, feel comfortable all day, feel motivated to perform work and school related tasks, feel motivated and comfortable taking part in social and creative opportunities; what would I gain from not taking the narcotics, other than a ridiculous kind of moral self-righteousness ("I'm toughing it out and living clean, even though my quality of life has diminished considerably, it's worth it so other people don't guilt trip me").

What's wrong, or bad, or immoral about taking a substance on a regular basis if it objectively improves your quality of life? I'd call that self-medication, and preferable to the alternative.

Where the line is doesn't seem too important. Everyone is different, and its been demonstrated even in this thread that taking any substance on a regular basis is already considered 'abuse' so it's an arbitrary label. It's up to the individual to decide what level of side effect or negative effects are acceptable.

 

[lolitaofott]

i always believed they were exactly the same.. a rose by any other name..

 

[sixpartseven]

It's definitely a difficult thing to distinguish, self-medication and abuse...

Because technically, they are the same thing.

Self-medicating is using drugs to treat something without first seeking medical advice. Usually the problem being treated is self-diagnosed, and the amount of whatever drugs you choose to use is not determined by a professional. This is also the definition of abuse. Abuse is using a drug in a manner it was not meant to be used, so technically, if it's not prescribed by a doctor, or if it's used in a way other than how it was prescribed, you're abusing it, but you're also self-medicating.

Even if you're absolutely positive you have, say, degenerative disc disease, and instead of going to a doctor for Vicodin, you buy them off the street, you're still self-medicating and abusing because your condition was not properly diagnosed and the medication not properly prescribed. You're using the Vicodin in a way it was not meant to be used because its not meant to be used at all until it's prescribed.

Another example is heroin addicts that buy Suboxone off the street. Even though it's obvious that Suboxone is the proper drug for them, they are still self-medicating, and since they are using an amount of Suboxone that is not approved by a specialist, they are technically abusing it. Although it's easy to argue that it's acceptable in this case because a Suboxone doctor will usually let you have some say in what dose you take, it's still abuse by definition.

One last example: someone is prescribed 8mg of Suboxone, but injects it instead of taking it sublingually. This is obviously abuse, but also self-medicating because the user is deciding for himself the "best" way to administer the medication.

With illegal drugs, I think the same rules apply, the only difference is it will always be abuse and will always be self-medicatinf. Even if you're just using for fun, its abuse because in reality, no drug was ever intended to be used for fun,and it's self-medicating because you are making a decision to take the drug to enhance some aspect of your life, whether it be boredom, sadness, pain, etc. You're medicating yourself based on a self-diagnosis of some "problem."

As for the issue of morals, I don't think its necissarily immoral to self-medicate. It depends on the circumstances, I suppose.

You could say I'm splitting hairs, but in the truest sense, they are one in the same.

 

[Pegasus]

^ I agree. I actually feel bad for a lot of people who aren't as informed about the drugs they are taking and rely solely on their doctors for medicating. Doctors should really only assist people in medicating themselves, not completely control it. People who need or even want drugs should be able to be open with their doctors about it, but they often can't, and either self-medicate outside of the legal system, or are forced to delegate to someone else their powers to medicate.

 

[MusicGuy]

they are the same things in my book. a drug user is a drug user; we are all in "it" for personal happiness. labeling something as self-medication is like a sugar-coating to make users feel better..

Unfortuantly not everyone is the same, so you can't group us all into one category. I first got into drugs out of pure curiosity, I wanted to see what new views it could give me, what I could learn, ect. I'll only "use" when I'm feeling my 100% best, why use any other time? If I'm at all depressed I won't touch drugs, at all. I use Adderall daily, when I can't get my months script I don't go looking for more Adderall. I typically get my life together, beat withdrawal, and make do without it. Without it it's extremely hard to focus, seeing as I've been on it for well over half a decade being off it isn't my favorite thing to do. But granted I can and have lived without it. And when I run out or can't get it it's not a big problem to me, of course I'd like some seeing as it makes my day easier, but I'm fine without it.

If I'm depressed I'll stop all drug use, that includes my medication (Adderall). I've never been addicted to anything, never used it to run from my problems, and never used it to make myself happy when I'm down.

If people use drugs for that... that's fine by me, they can do what they want. But not everyone is like that. I'm down to do any drug out there, but I do my research on it first. And on another note I've done most drugs out there, mostly psychedelics though. We can use without abusing.

 

[CrackAndScrabble]

The problem is with the logic of your question. You are trying to press your own psychological bias unto individuals. You are trying to draw a universalization of some very subjective terms. Its impossible. Thats exactly what doctors attempt to do with "disorders", they try and judge people on a "universal" standard, when its impossible to define to objectivefy human behavior.

This could be a nice little forum for people to say their own "subjective" opinions on whatever constitutes "self-medication" and "addict", but we cannot try and universalize human behavior. Thats what moral realists try and do and look at all they have done? Fuckin Christians

 

[laCster]

heh. you guys make me chuckle. i never said they are immoral at all. i said self-medication is the same thing as drug-use and possibly drug-abuse (dependent on the individual)

 

[xburtonchic]

I think the person crosses over the line at the point they stop taking the medications to simply feel better, and start taking them to feel high instead.

For instance, Person A and Person B both have a bottle of... let's say Percocet... at their disposal - same amount, same dosage, etc. Person A takes the whole bottle in three days for the purpose of just getting themselves through the day. Whether it's to avoid withdrawal or to avoid depression or whatever. Person B goes through the bottle in three days, but their only goal is to get fucked up. In that case, Person A is self-medicating, and Person B is abusing the drug. It's a pretty fine line.

I guess at the end of the day, it boils down to what's going on in the person's mind and what their true reasons are for taking it. Granted, Person A is probably slightly more likely to get addicted because they're genuinely trying to cover up a deeper problem (which I find to be the sole cause for a large number of drug dependency cases, and especially with opiates.) So as far as society's place in judging them goes... well, you shouldn't judge anyone, really. You never know what a person is going through. But at the same time, you can't blame a person for just trying to make it through the day when they've found the perfect cure for their depression and lack of motivation or whatever. It seems worse, to me, to actually abuse them for the sole purpose of getting high.

I'm not going to lie, it does piss me off when I see people casually downing opiates just because they want to get high. Opiates are definitely a substance to be respected. But like I said earlier, you also never know someone's actual intentions; we don't live in anyone's heads but our own. I guess it's not fair to judge someone who just wants to get high either... unless they're just being downright irresponsible and stupid about it. In which case, judge away. Better to get beat down by society's judgements than the opiates themselves... which will usually also lead to getting beat down by cops and prison inmates eventually as well. :/

I think any chemical or substance should be respected, and you should know exactly what you're putting into your body before you do it. Idk there's just so many different circumstances.

 

[Jakeperson]

Yes. But then, ALL soda drinking is a problem, and ALL drug usage is a problem. Because no matter how infrequently you drink soda or eat candy or smoke cigarettes or use drugs, you can't avoid negative side-effects from these activities. Even if you only take one puff of one cigarette in your lifetime, that puff is going to deposit a tiny layer of tar in your alveoli. Even if you only drink a single soda in your lifetime, that industrially manufactured corn-syrup saturated liquid is going to replace calories that would have come from real, nutritious food.

Although they may not be profound enough to be noticed, there are always negatives to drug use. Something's always "wrong" with using drugs. Does that mean that everyone that uses drugs has a problem?

I think what he was trying to say is "If you see it as a problem then it is one, if you don't; it isn't"


If you feel that it is right to shoot heroin every day than you would be denying who you are to not do it. That being said you need to be able to distinguish between your feelings and the drugs effect. Maybe something less addictive would be a better example.

My psychiatrist has helped me work through many problems, he, however does not care that I use drugs because to me it isn't a problem and therefore can't be fixed.