There are so many different drugs of use and abuse in our society; it is impossible to discuss more than a few in this text. Several appear commonly: marijuana, cocaine, heroin, prescription opiates, and ecstasy. These are perhaps the most commonly abused after alcohol in the self-management of anxiety.
Marijuana is a long-standing remedy used not just in this culture, but others historically, to help free people from the anxious chains that bind them. Many report that marijuana helps them to feel more free. It often creates a rebellious feeling, one of feeling able to do whatever one wants (the phenomenon commonly reported in adolescents wanting to belong to a group). Marijuana can allow people to feel that their inner selves are acceptable in a social setting, thus illustrating the basic dynamic of an anxiety disorder — that the feeling of shame that commonly accompanies anxiety is unacceptable.
Cocaine has a similar effect. Often people with post-traumatic stress disorder or the anxiety that stems from depression report that cocaine allows them the energy to stay up all night with friends or lovers talking about many details of their past in a way that feels intimate at the time. Cocaine can create a false sense of energy, security, and intimacy; it often goes along with depression and with the self-medication of depression.
Heroin and other prescription opiates, readily available on the Internet via sham doctors with licenses who make opiates available to anyone for the right price, help people with the anxiety of rage. In my experience, it seems that patients who abuse opiates the most tend to have a primary difficulty with anger, and that the anger, because of its destructive nature, makes them feel unlovable and worthless. However, the opiate also provides a euphoric kind of feeling that recreates feelings of genuine love and belonging. A colleague of mine who works with heroin addicts reports that up to 85% of the opiate addicts whom she treats have been sexually abused. It is not surprising that these patients would create or seek a medium through which they could gratify their appetite for love, but yet do so via a drug that involves no human contact.
Perhaps the most popular anxiety drug of abuse would be ecstasy, also known as the “love drug.” Patients who have used ecstasy at parties and overnight raves often describe feelings of absolute euphoria, love, belonging, and connectedness. They feel safe touching and loving each other, staring at each other’s genitalia, or sensing a blissful, babylike kind of safety in the world. That ecstasy works so well to dissolve anxiety in the short term is entirely compatible with what we know of serotonin’s impact in the treatment of anxiety. Ecstasy increases serotonin quickly and provides immediate relief. The serotonin medicines do so over weeks, with a similar, but a more muted, effect. It is important to keep in mind that ecstasy, like the reported positive effects of many drugs, provides only an artifice of intimacy. In fact, while people feel they are loving and sharing, they might also be acquiring sexually transmitted diseases or going home with partners they later regret having gone home with. Other users report grinding their teeth, developing high fevers, “disco dumping” (defecating in their pants), or ending up in a hospital from its effects on the body, none of which seems so desirable or loving.
Selections from the book: “100 Questions & Answers about Anxiety”, Khleber Chapman Attwell, MD, MPH, 2005.