It’s a Matter of Substance (or lack thereof)

I was talking with a young man the other day who was having a horrible time with depression. He had all of the classic symptoms, including severe insomnia. He also had no money, so his sleep med of choice was cannabis; when he could get it.

You know, I’ve never had a problem understanding why someone would want to use substances when they have nothing else to provide relief for emotional or mental distress. I certainly don’t condone it, but I would never pass judgment. We’re human, and we don’t like to hurt. And, of course, this reality makes those of us enduring emotional and mental situations very vulnerable to substance abuse and dependence.

So let’s briefly swirl some things around…


It doesn’t surprise me when a patient hits the highway after finding out the facility and campus are smoke-free. This after reporting for badly needed psych or substance-related treatment. Statistics tell us if someone started smoking before age 35, the odds of it killing them are 1 in 600. But aside from that, nicotine, a chemical stimulant, can further agitate our already wired body chemistry. With regard to anxiety, for example, research shows that daily smoking signaled an increased risk for the first occurrence of a panic attack. And the risk of panic is higher in active versus past smokers. Now, in addition to nicotine being a stimulant, some of this may have to do with the fact that smoking causes higher levels of carbon dioxide in our bodies. Oops – carbon dioxide is used to induce panic attacks in laboratory provocation studies.


Again, no surprise – research suggests anxiety and mood disorders are more prevalent in abusive drinkers. This is kind of an interesting tidbit. There’s a fascinating neurological phenomenon known as kindling. Simply put, kindling is a natural electrical stimulation of certain areas of the brain. It’s thought that chronic stress leads to an on-going kindling presence – which results in a hypersensitivity to stress. Ultimately, this electrical stimulation can occur without a precipitant at all – it just happens. It’s been suggested, for example, that multiple alcohol cessation/withdrawal episodes may be one of the chronic happenings that leads to stress hypersensitivity in susceptible individuals. And it’s this dynamic that may bring on mood and anxiety problems.

Cannabis and Recreational, Prescription, and Over-the-Counter Drugs

Aside from the pitfalls of using them as coping instruments, these chemicals can play a crazy tune on your brain, leading to all sorts of immediate and permanent consequences. I really believe extensive use of, and withdrawal from, these substances can lead to massive mood and anxiety problems. But it goes well beyond mood and anxiety. With regard to cannabis and the recreational drugs – LSD, heroin, cocaine, Ecstasy, GHB, Ketamine, Rohypnol, methamphetamine, you name it – more and more users are reporting, and presenting with, acute and chronic emotional/mental phenomena such as intense anxiety, paranoia, delusions, hallucinations, terror, and dissociative phenomena such as derealization and depersonalization – even after just one use. I’ve seen it in the E.R. and it isn’t at all pretty.

And let’s not forget about the perils of over-the-counter and prescription drug abuse and dependence. Now, I’m not so concerned about the abuse of antidepressants, but the benzodiazepines (Xanax, Ativan, Klonopin, etc.) must certainly be considered. Needless to say, they can very nicely take the proverbial edge off, and they’re addictive.

Abuse of, and dependence upon, the prescription opioid pain relievers, such as hydrocodone (Vicodin, Norco), oxycodone (OxyContin), meperidine (Demerol), etc. has become a huge problem. So many addicts began taking these meds after an injury, illness, or medical/dental procedure; and have found themselves eyeball deep in trouble. And, yes – they’re used recreationally as well. Oh – and what about the over-the-counter meds? Whether it’s cold, cough, sleep, or diet preparations, they can be very tempting and will take you to places you don’t want to go. Addiction, so stealthy, can strike out of nowhere.

Look, nobody’s perfect. As I said in the very beginning, we’re human – and we don’t much like pain. Heck, we often hurt so much that we may even find some sort of justification in drug abuse and dependence. But sooner or later the chickens are going to come home to roost, and things are going to get ugly.

Let’s do ourselves a big personal favor. Let’s not become entangled with these mind, brain, and hope grinders. And if you’re currently involved with them, you just have to do something about it. Don’t even blink about asking for help, okay? If you sense you’re a drug abuser – nicotine, alcohol, cannabis, recreational, prescription, or over-the-counter – please don’t neglect to tell your therapist, psychiatrist, or primary care physician. Your candor will allow them to help you clean yourself up, and your information will be held in confidence.

By the way, there’s no way I could have overcome my issues with mood and anxiety had I not put a cork in the bottle almost 26 years ago (and not a drop since).

Your thoughts and feelings, chipur readers? Won’t you comment?