Q. Would you give me some examples of direct versus indirect self-medication attempts?

A. Direct self-medication can occur with a substance that binds to receptor molecules on surface of cells. In this case there is usually a physical discomfort that is experienced when a person abruptly stops self-medicating with the substance (withdrawal). Drugs tend to disrupt functions of the brain’s frontal cortex where risks and benefits are analyzed, decisions are made, and conscience and willpower are activated.

Examples of direct self-medication include:

• Caffeine, nicotine, alcohol
• Prescription medications
• Over-the-counter medications
• Inhalants (legal or illegal)
• Illegal drugs
• Simple carbohydrates such as sugar

Drug use can actually alter blood flow patterns in the brain during the initial drug exposure, triggers pleasure, and creates a desire to repeat the behavior that produces the reward (reinforcement). The drug may disrupt frontal lobe function (thinking layer) directly and/or damage crucial dopamine pathways in the midbrain (action layer), information from which is transferred to the frontal cortex through altered neurochemical pathways. Drug use can also alter the distribution and density of dopamine receptors in the frontal cortex.

Eventually drug use can result in the disruption of frontal lobe capacity related to reason and control (e.g., appears to influence the individual to overvalue the reward, undervalue the risk, and fail to learn from repeated errors. A similar pattern can be seen in other disorders not classically associated with drug use (e.g., obsessive/compulsive disorder, poor choices).

Indirect self-medication can be accomplished through behaviors or actions that trigger changes in the brain’s neurochemistry (e.g., sexual compulsions, eating disorders, gambling). The addiction is really to the person’s own internal substances. There is some anxiety when the person stops acting out but not the same type of physical discomfort experienced during withdrawal from a direct substance. Examples of indirect self-medication include:

• Adrenaline that can be released during episodes of anger or fear, competition, and high-risk activities
• Endorphins and enkephalins that are released through: extreme exercise, bingeing/purging (e.g., released during starvation, overeating, or vomiting)., high-risk behaviors and activities; excessive hand washing, religious obsessions including flagellation, sexual activity (estimates are that 80% of sexual compulsions are accompanied by another concurrent addictive behavior such as alcohol, work, or gambling).
• Serotonin that can be released by eating specific types of foods, dopamine that can be released when an unexpected reward or a larger-than-anticipated level of an expected reward is received, oxytocin and vasopressin that can be released during sexual activity and/or by a feeling of being in love.