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Self-Harm and Substance Addiction

Self-harm and substance use disorders are complex behavioral health issues. While both issues may be addressed with behavioral health interventions, the path to recovery may require a great deal of commitment and perseverance. Those struggling with both self-harm and addiction may feel hopeless, or that tackling both conditions is impossible. However, an integrated treatment approach can simultaneously address self-harm behaviors and substance addiction and start you on a path to recovery.

What is Self-Harm?

Self-harm is the act of purposely hurting yourself. This behavior can occur as a maladaptive means of coping with overwhelming emotions, combatting feelings of numbness or emptiness, to distract from upsetting memories, or to feel a sense of control.1 Those who self-harm may also consider the behavior a form of self-punishment.1

Self-harm should not be confused with a suicide attempt. It is possible for someone to self-harm without ever having an intention of attempting suicide. It is likewise possible for someone to attempt suicide without ever participating in self-harming behaviors. While self-harm can be a potential risk factor for suicidal ideation or intentions, these terms are not synonymous and should not be used interchangeably.

While self-harm and suicidality are entirely different behavioral issues, they can co-occur, which means that a person can have both of these behaviors simultaneously. Self-harm can also co-occur with the following:1,2

  • Mental health disorders (depression, anxiety, PTSD, borderline personality disorder).
  • Eating disorders.
  • History of trauma (abuse, neglect, loss).
  • Substance abuse.

Different types of self-harm

Self-harm methods can vary from person to person, and some people may use multiple means of self-harm. Below are some of the behavior’s that fall under the category of self-harm:1, 2

  • Cutting skin with a sharp object.
  • Hitting or banging yourself into objects.
  • Punching yourself or other objects.
  • Burning your body.
  • Attempting to break bones or bruise yourself.
  • Picking at wounds.

What is Substance Abuse?

Substance abuse involves patterns of drug or alcohol use that can lead to significant problems or distress in a person’s life.3 Persistently problematic patterns of substance use may be signs of a substance use disorder, or addiction. Substance addiction is a medical condition that in which compulsive drug and/or alcohol use persists despite the associated adverse consequences.3,4 In some cases, people begin using substances recreationally, and use escalates over time until the substance becomes increasingly important. As a person begins to become increasingly negatively impacted by their substance use, they may meet the criteria for being professionally diagnosed with a substance use disorder.4 For you or someone you know to be diagnosed with a substance use disorder, at least two of the following criteria must be met within a 12-month period:5

  • Taking the substance in larger amounts or for longer than intended
  • Wanting to cut down or control the use but not being able to
  • Spending a great deal of time getting the substance, using it, or recovering after use
  • A strong desire, craving, or impulse to use the substance
  • Continuing to use the substance even though it negatively impacts your work, school, or home life
  • Continuing to use the substance even though it is negatively impacting your relationships with others
  • You no longer participate in important social, occupational, or recreational activities due to substance use
  • Using the substance in risky or hazardous situations, such as driving a car
  • Continuing to use, even though the substance is causing or making a physical or psychological issue worse
  • Building up a tolerance to the substance and needing increasing amounts to feel the desired effect
  • Experiencing withdrawal when the substance is stopped, or continuing to use to avoid these adverse symptoms

Treatment for Self-Harm and Substance Abuse

When a person is diagnosed with substance use disorder and one or more mental health disorders, it is referred to as a dual diagnosis or co-occurring disorders. Co-occurring disorders may benefit from specialized, integrated treatment that addresses both mental health disorders simultaneously.6

Due to the impact substance use disorders and mental health disorders have on one another, it can be challenging to tease out how each impacts the other. Treating both of these at the same time may allow more of the person’s needs to be met and, hopefully, lead to a better chance at a successful outcome.7

Though self-harm isn’t itself a distinct mental health diagnosis, the problematic behavior is sometimes seen as what’s known as a comorbidity with mental health conditions that themselves co-occur with substance use disorder. Treatment that targets these mental health disorders may improve the self-harming behavior.1

Therapy Treatment for Self-Harm

Though there are no medications specifically approved to treat self-harming behaviors, there are medications that can help manage any associated mental health conditions such as depression or anxiety.1 Instead, self-harming behaviors may more specifically be managed with behavioral therapeutic interventions.1,2

Some behavioral treatments that may help self-harming behaviors are:2

  • Psychodynamic therapy to more closely examine past experiences and the emotions associated with them that may give rise to maladaptive, self-harming behaviors.
  • Cognitive-behavioral therapy (CBT) to identify and change potentially negative thought patterns and behaviors, as well as to increase coping skills.
  • Dialectical behavior therapy to help a person develop more adaptive or positive coping methods.

Behavioral therapy is also a cornerstone of substance use disorder treatment. Some treatments that may help treat substance use disorder are:8(pg 49-on)

  • Cognitive Behavioral Therapy (CBT).
  • Contingency Management.
  • Motivational Interviewing.
  • Dialectical behavior therapy.
  • Rational Emotive Behavior Therapy.
  • Matrix Model.

How to Help Someone Who Self-Harms?

Some potential warning signs to look out for if you are concerned about a loved one possibly engaging in self-harm are changes in mood or behavior, wearing long sleeves or pants even when not appropriate for the weather, or frequent bruises or bandages.1 If you are worried that you may know someone who is struggling with self-harm, there are ways to help. First and foremost, try to remain calm and non-judgmental if you decide to discuss the issue. It will also be important to help them identify some resources to help them find support. Some of these resources are as follows:2

  • 24/7 Crisis and Access line: 1-800-939-5911.
  • National Alliance on Mental Illness.
  • Self-Injury Guidance and Network Support.

How to Find Rehab Treatment Centers Near Me

When seeking treatment for both a substance use disorder and a behavioral health issue like self-harm, make sure to find a treatment that can address both at the same time. This may mean finding treatments that target any co-occurring mental health issues or working with a provider to participate in treatments that targeting all issues simultaneously.

Finding local treatment centers can be difficult. below are some links that may be helpful:

Another thing to consider when looking at treatment options is local or out-of-state treatment. While local treatment facilities can allow you to remain close to pre-existing support networks, they can also leave you vulnerable to triggers that may worsen your self-harming behaviors or substance abuse. Out-of-state treatment, while possibly stressful due to the lack of support, can help you be removing you from your usual environment, allowing for full focus on recovery.

Does Insurance Cover Self-Harm and Substance Abuse Treatment?

Your insurance may cover substance use and mental or behavioral health treatment, but to what extent depends on your state, the particular type of insurance, and what policy you have. The Affordable Care Act (ACA) mandates that insurance plans must provide some kind of coverage for substance use disorders and mental health issues, including those with behavioral elements such as self-harm.9 To determine the extent of your coverage, contact your insurance provider or check your coverage online.

Sources:

  1. U.S. National Library of Medicine. (2016). Self-harm.
  2. National Alliance on Mental Illness. (2021). Self-harm.
  3. American Society of Addiction Medicine. (2019). Definition of Addiction.
  4. National Institute on Drug Abuse. (2018). The science of drug use and addiction: the basics.
  5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, Washington, D.C.: American Psychiatric Association.
  6. MedlinePlus. (2021). Dual diagnosis.
  7. National Alliance on Mental Illness. (2020). Substance use disorders.
  8. NIH Publication. (2012). Principles of drug addiction treatment: a research based guide.
  9. Healthcare.gov. (2021). Mental health and substance abuse coverage.

 

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