This week, I’m going to talk more specifically and clinically about substances and their effects on you.
Last week, we gave you broad information about substance use and factors related to your biology and family history that leave you at risk for addiction. This week, I’m going to talk more specifically and clinically about 4 legal substances and their effects on you.
Savvy Psychologist is hosted by Dr. Monica Johnson. A transcript is available at Simplecast.
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Have you been wondering how the drugs you’re using or thinking about using could be affecting you? Then this is the episode for you! Welcome back to Savvy Psychologist, I'm your host, Dr. Monica Johnson. Every week on this show, I'll help you face life's challenges with evidence-based approaches, a sympathetic ear, and zero judgment.
Last week, I gave you broad information about substance use and factors related to your biology and family history that leave you at risk for addiction. This week, I’m going to talk more specifically and clinically about substances and their effects on you.
According to the DSM-5, a substance use disorder—or SUD for short—involves patterns of symptoms caused by using a substance that an individual continues taking despite its negative effects. The DSM has 11 criteria, and based on how many criteria a person meets, your SUD will range from mild to severe. The criteria are as follows:
When you use a substance, a relationship forms between your body and the drug. For many people, this relationship is stable and doesn’t create negative consequences. This is what we mean when we say use in moderation.
However, at times things get out of balance and you can begin to misuse a substance. You may start to use it in secret or do so more impulsively despite the negative consequences. You may also notice dependence, which happens when your body begins to adapt to a specific substance. You will know that you have developed a dependence when you start to experience withdrawal symptoms in the absence of the substance.
Tolerance is when you need more of the substance to get the same effect. For instance, it may have only taken you 2 beers to feel buzzed in the past, but now it takes an entire 6 pack. That’s an example of tolerance.
Just because you don’t see yourself as addicted doesn’t mean that your use isn’t problematic and could eventually lead to worsening issues. There are many who claim to not struggle with use, but could you quit your substance of choice for a month? Try it and let me know how it goes.
Your chance of becoming dependent on a substance varies based on the person. For any individual, the chance of dependence will range from very low to very high, depending on factors like family history and genetic vulnerability. Check out the previous episode for more information on these factors. Additionally, the quantity and frequency of use plays a role.
Keep in mind that all drugs have their own addiction potential. Hallucinogens have a very low potential for addiction, where drugs like meth have a very high potential for addiction. Do you remember those meth ads from more than a decade ago? Their tagline was “not even once,” because quite honestly for some that’s all it took for them to become addicted to the substance.
Now I’m going to give you the lowdown on a few legal substances that folks ask me about on a regular basis.
The first substance I’m going to talk about is nicotine. While it’s less socially acceptable to smoke cigarettes these days, it’s still a fairly common practice. When I speak about nicotine, I’m talking about smoked and smokeless tobacco as well as e-cigarettes.
Nicotine is highly addictive and the leading cause of preventable death in the U.S., killing about 480,000 people per year. One of the reasons why it’s so addictive is that nicotine easily passes through the blood-brain barrier, and it can be hard to quit because of how intense the withdrawal symptoms are. They include: cravings, poor concentration, headaches, sleep disturbance, mood changes, anxiety, stomach issues, and increased appetite.
Oh, the beloved Starbucks. A fun fact about me is that I don’t drink coffee. I consume little to no caffeine on a daily basis. Worldwide, caffeine is the most used psychoactive drug. One of the things I caution patients about with caffeine is using it as a replacement for good health habits like proper sleep.
Caffeine can actually lead to increased issues with insomnia, restlessness, or agitation. So, sometimes the thing you’re using to solve a problem could be creating or exacerbating that very same issue!
The withdrawal symptoms of caffeine are as follows: fatigue, difficulty concentrating, drowsiness, craving, depression, nausea, muscle aches, and the dreaded headache. The headache is the biggest complaint I see from patients when they initially attempt to reduce or eliminate caffeine. I encourage you to push through it—it won’t last forever and reducing your dependence on caffeine will be good for you in the long run.
Alcohol is sneaky. Lots of people use it and it’s socially acceptable to drink in this country. But there are many people who engage in problematic drinking and don’t even realize it. The National Institute on Alcohol Abuse and Alcoholism, or NIAAA, defines heavy drinking as drinking more than 4 drinks on any given day or 14 alcohol drinks in a week for men, and 3 or more drinks on any given day or more than 7 drinks in a week for women. SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.
By these definitions, there are many people who qualify as heavy or binge drinkers who may not realize they have a problem. For reference, in the United States, one "standard" drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in:
Some of the withdrawal effects of alcohol include: nausea, vomiting, cravings, malaise, irritability, insomnia, irritability, tremors, depression, sweating, anxiety rebound, agitation, tachycardia, fever, delirium, orthostatic hypotension, and fever. Depending on how much a person has been using, they may need medical intervention in order to get off alcohol.
I will close out our conversation by talking about cannabis. It’s not legal in every state in the US, but it has become increasingly decriminalized and legal.
In most circles, folks don’t bat an eyelash when a person discloses using marijuana. In fact, it is the most abused illegal drug in the world. While people may use it to cope with bad moods, you want to be careful with this.
A common debate I have with my patients is regarding self-medicating vs speaking to a professional. When a doctor prescribes you medication, they give you a certain dosage on a schedule—for instance, 10mg daily. You will remember from last week that all drugs have side effects. Your medical professional has done a cost-benefit analysis based on your health, family history, and the condition from which you are suffering to come up with a medication regimen that will work for you.
Also, remember that last week I said the body's response to a drug is to try to create the opposite effect. This is key to what I’m about to say next. When you self-medicate, your use is based on your mood, which means the dosing and schedule fluctuate, and depending on how your body reacts, you can create more of the same problem. I’ve had patients who self-medicate and it meant that they were using off and on all day every day in order to stay in a state of intoxication.
While cannabis can lead to a sensation of relaxation, it can also make it difficult to function due to issues like impaired memory, judgment, and slowed thinking. Additionally, marijuana doesn’t actually cure or reduce anxiety, it masks it like any other illicit substance. For some, cannabis can lead to feelings of paranoia—which is counterproductive. You always want to be mindful about the reasons why you use marijuana, otherwise the idea of moderation can quickly get thrown out the window.
Withdrawal symptoms from cannabis include: insomnia, depression, inability to concentrate, restlessness, hyperactivity, irritability, anxiety, anger, loss of appetite, or nausea.
I hope that you will take this information and be thoughtful about your substance use. If anything I’ve said here has made you question if you’re actually using in moderation, please speak to medical or mental health professionals.
Was there anything I said about substance use that surprised you? Let me know on Instagram @kindmindpsych. You can also reach out to me via my email at firstname.lastname@example.org, or leave a voicemail at (929) 256-2191.