What do we mean by “self-medication”? It certainly includes the use of actual medication and other substances to feel better, but more broadly, it includes anything that offers an in-the-moment escape or avoidance. Just like using procrastination to cope with anxiety, the immediate sensation is relief, but the long-term result increases the problem. Here’s how I know the difference: When I am practicing self-care, I rarely if ever feel regret or shame afterward. Self-medication, however, often leads to regret.
Any substance or behavior can be used to self-medicate: to numb out, avoid, or distract from what truly needs attention. I’m going to focus on the common manners in which self-care has lost its way, appearing to work the “best” to help our anxiety, but in reality serving to increase it, sometimes with devastating outcomes. As you work to uncover your own patterns, the main questions to ask are these: Am I using this to escape or eliminate my feelings in the short term? How is it working in the long term?
Sleep, Self-Care, and Self-Medication: It’s Kind of a Mess
“I never have any time to myself,” says 34-year-old Leah. The divorced mother of 6-year-old twins works full time and is active in local politics. She’s exhausted and irritable, and often has difficulty sleeping. Each night, she gets the twins in bed by eight o’clock and then usually drifts off with them as they read or snuggle. Waking about an hour later, she picks up the house and prepares for the next morning, then finally climbs into her bed with her laptop to relax with Netflix. “This is my treat, my time alone,” she says.
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Leah’s story is typical. The self-care she wants and deserves at the end of her day sounds good, but the short-term pleasure of staying up late and using a screen in bed are creating long-term problems. Is watching Netflix always self-medication? Of course not. But denying herself adequate sleep to get the “reward” of alone time is backfiring. When the alarm goes off at 5 a.m., Leah regrets staying up too late. When she is irritable with her children and unfocused at work, she vows to fix the problem. So she goes to her doctor, complains of difficulty sleeping, and leaves with a prescription. Does she add caffeine to the mix? Likely, and that extra cup of coffee she craves becomes another “reward” that she has earned.
Look, I get it. I watch Netflix, too. Do I still at times stay awake too late when I know I have an early day? Yes, but very infrequently. I am much more honest with myself about the price I pay and the regret I will feel. But if your “self-care” is really a way to compensate for an actual lack of self-care, it’s not self-care. Adequate sleep is good self-care. Denying yourself sleep and calling it a reward, then trying to compensate for the lack of sleep with substances is self-medicating.
If you are anxious, irritable, stressed-out, and generally feeling crappy, sleep needs to be high on the list of your self-care priorities. Research has shown over and over that despite our best efforts at justifications and rationalizations, our brains and bodies want adequate sleep and suffer when we don’t get it. Other researchers have found that without adequate sleep, we are less empathetic, more sensitive to pain, and less aware that we are even having cognitive difficulty.
A Cocktail of Mixed Messages: Alcohol and Anxiety
Alcohol. How do you view it? What is your relationship with it? I don’t want to sound too judgmental, but—fair warning—I’m probably going to be a bit judgmental. My judgment is not aimed at you; it’s aimed at the way alcohol and other substances are promoted as the vital and often most effective solution to our hectic, anxious lives. Like many of the sneaky tactics of anxiety I’ve described, these substances draw us in because they often reduce our anxiety and stress dramatically in the short term, and this is the very aspect that makes them so appealing and compelling. For example, take mommy wine culture, with memes and T-shirts and Etsy merchandise that often use humor, self-deprecation, and some blaming of children to justify alcohol as the reward for getting through the day. The reward? Rates of alcohol use disorder (AUD) have increased in women by 84 percent over the past 10 years relative to a 35 percent increase in men.
I recently saw an ad for personalized wine bottle labels being marketed as teacher gifts. The labels are customized with a picture of your child and a message: “Your child may be the reason they drink, so let them know how much you appreciate everything they do with our humorous and light-hearted The Reason You Drink Personalized Wine Bottle Label, attached to a nice bottle of wine!” said the ad (italics theirs, not mine).
I am not going to globally say that consuming alcohol is bad, but I would never include it on a list of self-care strategies. Researchers have found that anxious people who report using alcohol to self-medicate are much more likely to develop alcohol dependence.
When the Line Is Even Trickier
What about the things we do that are good for us, until they’re not? How do we know when self-care moves into self-medication?
- When you feel regretful after the fact
- When you notice yourself becoming increasingly rigid about the activity
- When the goal of the activity is almost entirely in the category of “making you stop feeling bad” instead of making you feel replenished
Let’s use exercise as a great example. Exercise or physical activity is solidly in the self-care category. Researchers consistently find exercise to be helpful for the treatment of anxiety and depression. If I had to pick only one thing that I could force my anxious clients to do to help with their symptoms, I’d pick exercise.
Several years ago, though, I was working with two parents and their three children. The mom (I’ll call her Carrie) was a runner, and she talked about how it helped her anxiety tremendously. She never regretted going for a run, although she sometimes regretted missing a family event or angering her partner with her inflexibility about it. It boosted her mood and made her calmer, she said. She needed it.
When Carrie arrived for one session dressed in her running gear and adamantly argued that she needn’t be present for the session with her daughter because she had a run planned, it was time to help her differentiate between self-care and a more addictive pattern. Not being able to run for any reason became an anxiety-provoking emergency. This meant that much of her thinking when she was not running was worrying about what might get in the way of her run.
She was a skilled self-medicator, a darn good avoider, an expert catastrophizer, a professional ruminator. Running was absolutely a better choice than some other stuff she’d used to feel better, like spending money she didn’t have on clothes. Running on the road, she joked, worked much better than running up her credit cards. Running moved more into self-care when she was able to take the patterns of anxiety—her global, catastrophic, rigid, avoidant responses—out of it.
When an activity, whether it’s running or drinking or shopping or cleaning, becomes a primary way to avoid, and even becomes the only way to find temporary relief, it means your self-care has become too rigid, compulsive, and anxiety-provoking. Are you rewarding yourself or simply trying to avoid dealing with yourself?
Acknowledging these patterns and working to shift them will become the best overall self-care solution, the road map to better responses when anxiety and stress show up, which they will. Anxiety left unrecognized, unchecked, and unexposed gets in the way. There is no finish line or being done; managing your emotional and social self is about maintenance, a consistent resetting and rebooting. Step forward. Adjust.
The Anxiety Audit: Seven Sneaky Ways Anxiety Takes Hold and How to Escape Them
The Anxiety Audit: Seven Sneaky Ways Anxiety Takes Hold and How to Escape Them
About the Author
Lynn Lyons is a psychotherapist specializing in the treatment of anxiety in adults and children and has been in private practice for 30 years. She is also the cohost of the podcast Flusterclux (@flusterclux).
