Over the last 25 years there have been many studies and contributions toward understanding the nature of addiction. The most frequent reason addicts give for their abuse of drugs and alcohol is so that they can control intolerable or overwhelming emotional states. This phenomenon is referred to as the "self-medicating hypothesis."
Addicts use particular substances to manage specific overwhelming emotions. For instance, anger, anxiety and loneliness can be managed with alcohol or opiates, while depression, boredom and emptiness can be managed with cocaine, methamphetamine and other stimulants. It seems that for any emotional state, there is a corresponding drug that can counter-balance it.
While these "solutions" may work well in the short-term, they have devastating long-term effects. Drug use and addiction lead to problems in relationships, families, jobs, legal troubles and adverse health effects among others. In fact, using drugs to manage uncomfortable or intolerable emotions actually causes other emotions to increase. For instance, abusing alcohol on a regular basis has been shown to cause depression rather than relieve it.
Good Drugs vs. Bad Drugs
It is important, however, to distinguish the difference between medically prescribed medications to manage symptoms (e.g. an antidepressant to manage depression) versus the abuse of prescribed drugs (taking more than prescribed or taking medications prescribed to someone else) or use of illegal drugs (heroin, crack cocaine, etc.) to manage the same symptoms. Medications prescribed by a doctor taken exactly as prescribed is an important part of our recovery. It is important to note that the prescribing doctor must be made aware of our history of addiction in order for the both of you to make the best decision regarding your care. Honesty truly is the best policy here.
Once we start using drugs to "self-medicate," we begin a process of positive reinforcement; our use of a drug to effectively manage an uncomfortable emotional state is a positive experience and one we want to repeat. This cycle then leads to addiction.
Dealing with Life Head On
The truth is, no matter where we are in the process of active addiction, treatment or recovery, we will always face high emotional states. Everyone experiences occasional high levels of anger, depression, loneliness, anxiety, etc. The focus for those of us in recovery lies in how to deal with those inevitable emotions without using drugs or alcohol to self-medicate.
One of the most important concepts of mindfulness meditation is to be kind to yourself. When we draw our attention to the present moment (what do I see, hear, smell, taste, feel?) our minds will do what they are created to do—think. When we notice that our thoughts have wandered from the present moment, we need to lovingly call ourselves back and again focus on the present moment.
Let's take anxiety, as an example. How can mindfulness help us deal with this emotion without needing to resort to self-medication? Here are the steps to take to in order to work through the temptation.
1. Pay attention to your body.
Emotions are typically felt in bodily sensations. We may experience anxiety in our temples, neck, chest, stomach, legs or somewhere else. Take some deep breaths and scan your body from head to toe. Where does the anxiety seem to be? Maybe it's a throbbing in your head, a knot in your gut or a sensation somewhere else. You may find that the physical sensation is uncomfortable and that is OK. Simply notice it and pay attention to it.
2. Sit with the feeling.
When I’m experiencing severe anxiety, I feel a tightness in my chest. I'm aware of it but I need to remind myself that this feeling is okay. It may not be comfortable and the feeling may be worrying, but it's only a feeling and nothing more. I'm okay; this feeling is simply a result of my anxiety and nothing more. Be non-judgmental about this feeling and simply notice it. Let's face it, as addicts we don't like to feel uncomfortable physical sensations. However, these physical feelings will NOT kill us and we do not need to numb them by using drugs or alcohol. Feelings don't control us; in fact, we control them. So be an explorer instead and think to yourself, “Hey, this anxiety makes my chest feel tight. How interesting.”
3. Identify the emotion.
As addicts, we are not always aware of the specific emotions that we're feeling. In my experience, each emotion was like a piece of yarn. Over time those different pieces of yarn kept adding to the “ball” until I couldn't stand it and turned to drugs and alcohol to relieve the pain. When I started treatment for my addiction, my therapist asked me to identify the emotions that I experienced during the last 24 hours. Embarrassed, I admitted that I could only identify fear and anger. She then supplied the following basic emotions to add to my self-understanding: Mad, Glad, Sad/Hurt, Scared, Guilt, Shame, Proud, Lonely, Rejection, Abandoned, Grief and Love. Before learning about these emotions I would just let everything “pile up” until my emotional state was so painful that I had to self-medicate with drugs or alcohol. In learning how to identify these emotions and use mindfulness to accept them and deal with them, I’ve discovered a new life where my emotions do not have to be managed by addiction.
4. Accept the emotion.
Are you angry, anxious, and/or depressed? Whatever the emotion, know that you are NOT alone. Every human being experiences these emotions and finds them uncomfortable. The difference is in how we deal with these emotions. As addicts, we want to numb these uncomfortable emotions with drugs and alcohol. When our brain says, “I'm anxious and I don't like the way that makes me feel,” addiction responds by saying “This drug will make that feeling go away.” Through mindful acceptance, you can embrace difficult feelings with compassion, awareness, and understanding towards yourself. You will begin to experience these emotions in a more fleeting manner, like clouds that pass by in the sky, and create in yourself a space of awareness, curiosity, and expansiveness.
5. Let go of control.
Mindfulness teaches us to embrace the emotion that we’re experiencing, recognize it, and let it go. The truth is, we cannot control how a situation makes us feel. If a situation causes me to be angry, afraid, anxious, or anything else, you will feel those emotions and consequently have to deal with them. While we cannot control the emotions that arise from any given situation, we can control how the emotions affect us. This is where mindfulness comes in. Once I identify the physical feeling in my body, I can acknowledge it and let it go. It no longer has any power over me.
These six steps can be used in a wide variety of emotional experiences. The more we practice mindfulness meditation in our daily lives the easier the practice will get. This is not a cure-all to eliminate high emotional states – as we will still feel uncomfortable emotions – but mindfulness will enable us to take control of them rather than letting these emotions control us. Remember to be patient and kind to yourself in practicing mindfulness. There is no “right” or “wrong” here; mindfulness meditation is a proven method of dealing with “life on life’s terms” without using drugs or alcohol to numb our emotions. Focus on the “NOW” of life and free yourself from the pain and suffering of addiction.
 Frances, R. J., Miller, S. I., & Mack, A. H. (Eds.). (2005). Clinical textbook of addictive disorders (3rd. ed.). New York, NY: The Guilford Press.