Motivation and emotion/Book/2025/Drug use as emotion regulation

Drug use as emotional regulation:
Why do people use drugs to cope with difficult emotions?

Overview

Figure 1. Young adults partying in a nightclub. Case study Jackie is a 22-year-old student who is struggling with increased anxiety and depression due to overwhelming stress from her academic life. Whilst Jackie is a good student who puts in long hours studying, she often finds her heart racing, unable to focus efficiently. As well as issues with studying, Jackie is exhausted, and unable to put as much effort and "happy" energy towards her social life, with her friends stating that she has become "boring" as they often hang out in high energy environments such as nightclubs (see Figure 1). Due to these life circumstances, Jackie started smoking marijuana during the week to aid in calming her anxiety, as well as taking MDMA {ic|Explain abbreviation}} on the weekends to give a happier, energetic and fun approach to social events. What are some possible biological, social and emotional effects Jackie may experience through trying to self-regulate her emotions through drug use?

According to an international study from the Global Burden of Disease, there were 600,638 deaths from illicit drugs within 2021 (Ritchie et al., 2022). Initial illegal drug use has often been found to be linked to one of three main motives: coping motives, enhancement motives and social motives, (Gold et al., 2021). Coping motives are defined as substance use aimed to self-medicate negative emotional states, an act of emotional regulation (Gold et al., 2021).

Emotional regulation (ER) is the ability for an individual to identify, evaluate, adapt and manage emotions and emotional changes in both a personal and socially acceptable manner, (Paulus et al. 2021). When emotional dysregulation (ED) occurs, individuals will often turn to unhealthy coping mechanisms and self soothing behaviours, as the individual is unable to handle extreme feelings of stress and negative emotions, (Wong et al, 2013).

Drug use as emotional regulation is often a common coping mechanism due to symptoms of either emotional bluntness or feelings of joy and happiness, (Van Hedger et al., 2021). Substance use can be triggered by stressful early life environments such as child abuse, and can quickly develop into drug addiction, (Hogarth et al., 2019). Drug addiction can cause temporary and permanent issues to individuals for within ER.

Focus questions What is emotional regulation? How does drug use begin as emotional regulation? What are the effects of drug use being used as emotional regulation?

Understanding emotion regulation

Emotions can be beautiful and constructive within every day life, although can quickly become destructive. Destructive emotions occur when emotions become too intense, last for long periods of time or are expressed in inappropriate contexts (Zareban et al., 2017).

ER is almost always influenced by the intensity of the present emotion in reaction to internal or external stimuli (Kozubal, 2023). Emotions are a crucial, unavoidable psychological process that every individual experiences to adapt to environments and situations as well as achieve their goals (Kozubal, 2023). Emotions are circuit responses through innate programming to stimuli, (Murphy et al., 2012). When emotions are triggered from external stimuli, neurotransmitters such as dopamine, noradrenaline and serotonin are released as well as hormonal releases and an increase of heart rate (Murphy et al., 2012). Emotions can be looked at as either regulating or regulated factors (Zareban et al., 2017).

ER processes, as shown in Figure 2, are attentional, cognitive, behavioural, social and biological and are often associated with varying personal traits (D'Agostino et al. 2017). ER is frequently achieved through adaptive strategies based on goal orientation, and these processes are often categorised into four parts; (1) understanding of emotions, (2) acceptance of emotions, (3) ability to act in purposeful goal oriented behaviour ways during negative emotions, and (4) ability to identify and act in appropriate behaviours to regulate emotional responses (Zareban et al., 2017). Forms of ER such as cognitive reappraisal, mindfulness and acceptance are associated with higher rates of wellbeing (Stellern et al., 2022).

Figure 2. Flowchart of key aspects of ER.

Emotional dysregulation (ED) is the inability to use healthy strategies in order to diffuse and regulate negative emotions (Rolston & Llyod-Richardson, n.d.). ED is unable to be directly measured, but can be seen through symptoms of hyperarousal, mood instability, irritability and aggression, due to the act of internalising/ externalising mental disorders (Paulus et al. 2021). ED has been associated with engagement of high risky behaviours and frequent sexual behaviours with multiple partners, as well as linked to psychological models and diagnoses criteria of many psychological disorders involving emotional turbulence including borderline personality disorder, major depressive disorder, bipolar disorder (BD), generalised and social anxiety, eating disorders, and substance abuse disorders (Zareban et al., 2017).

How does drug use begin as emotion regulation?

Individuals, particularly adolescents and young adults, with defects in coping with stress, organising and adjusting to influential emotions, thoughts and behaviours have been associated with onset and rapid increase of substance abuse, (Wong et al., 2013). Young adult Australians aged 18 to 25 years are the most likely age group to engage in the use of illicit drugs (ADF, 2025). Research has suggested that substance use is not a cause of psychological issues, but rather a symptom of an individuals ability to handle stress and distress, (Wong et al, 2013).

Figure 3. Operant Conditioning Flowchart.

A main motive for engagement of substance abuse is often both positive and negative enforcements, (Murphy et al., 2012). Substance use related ED is due to a heightened reward sensitivity to the substance, and simultaneously lowered sensitivity to the neurological responses to stress, (Murphy et al., 2012). This phenomenon is most basically explained in relation to Pavlov's operant conditioning theory, (Murphy et al., 2012). Operant conditioning theory, as shown in Figure 3, demonstrated that when the stimuli that promotes substances engaged in through certain environments, begins to result in automatic stimuli seeking behaviour when exposed to that particular environment, (Murphy et al., 2012). In terms of ER, this translates to when an individual uses drugs in order to self regulate when certain emotions arise, whenever that emotional state occurs the individual will have an automatic response to chase the use of particular substances.

Individuals with intense environmental states, genetic dispositions and pre existing mental disorders will often engage with substance use as a from of self-regulation/treatment as drugs offer temporary symptom reduction from the negative stimuli and emotion (National Institutes on Drug Abuse, 2020).

Environmental influences

Research shows growing evidence that stressful early life environments and chronic stress affect the mesolimbic dopamine pathways that are associated with self treatment in adults and adolescents through substance abuse as ER (Sinha, 2008).

Stressful early life environments include physical, sexual and emotional childhood abuse, neglect and unstable households manifesting in forms of: parental substance use, conflict, mental illness or household incarceration) (SAMHSA & Office of the Surgeon General, 2016). Adolescents in general is also a risk factor of initial substance use as it is often an experimental life period. Many adolescents engage in trying alcohol and drugs due to intense desire for risk taking and experimenting as well as social factors such as peer pressure (SAMHSA & Office of the Surgeon General, 2016).

General and major stress both alters neuron activity as well as being a major risk of relapse (National Institutes on Drug Abuse, 2020). High levels of stress reduced activity within the prefrontal cortex and increased activity in the striatum causing symptoms of decreased behavioural control and increased impulsivity and risk taking (National Institutes on Drug Abuse, 2020). Intense stress also alters dopamine pathways and signaling, often enhancing reinforcing properties of drug use (National Institutes on Drug Abuse, 2020).

Genetic influences

Genetic factors such as specific gene variants are also hypothesised to account for between 40 to 70 percent of individual differences in risk and engagement of substance use (SAMHSA & Office of the Surgeon General, 2016). Specific gene variants are responsible for the metabolism of alcohol and nicotine as well as strengthening of neuron connections to form drug memories (SAMHSA & Office of the Surgeon General, 2016). These gene variants can either predispose or protect from potential inclined substance use (SAMHSA & Office of the Surgeon General, 2016).

Epigenetic impacts also help to explain possible factors for engagement of initial drug use. Animal studies have shown promising association to human development. For example, some animal studies have begun to show that high fat maternal diets during pregnancy influences proteins in the reward pathway, influencing drug reward states later in life (National Institutes on Drug Abuse, 2020). Varying animal studies have also showed that low maternal care in early stages of development altered ability to adequately respond to stress, a contributing factor to initial substance use (National Institutes on Drug Abuse, 2020).

Mental health and disorders

Certain mental disorders such as BD and PTSD are hypothesised as a risk factor for substance use engagement through a form of self-regulation of extreme emotions, anxiety or to avoid dealing with on going trauma symptoms and more risky inclined behaviours (National Institutes on Drug Abuse, 2020). Individuals with ADHD are also shown through neuroimaging to be more inclined to substance use do to differences in brain circuiting associated with cravings (National Institutes on Drug Abuse, 2020).

Drug addiction and classifications

Dependant on the classification and jurisdiction in which the drugs are taken means the drug may be considered legal or illegal, (Farzam, et al., 2023). Laws and policies surrounding drug use are also influential in inflicted and reduced harm. Prohibitionist policies that prevent use and access to illicit drugs may influence negative social stigmas, create dangerous environments where drugs are created and sold, increase health concerns and decrease harm reduction strategies, (Anderson, Rehm, & Room, 2015, p. 1948).

Drug addiction

Severe substance abuse disorders are referred to as addictions, (Substance Abuse and Mental Health Services Administration [SAMHSA] & Office of the Surgeon General, 2016). Addiction is formally defined by the National Institute of Drug Abuse, (2020) as a 'chronic, relapsing disorder characterised by compulsive drug seeking and use despite adverse consequences'. Although addiction is often seen as a character flaw, it is now being referred to through research as a chronic brain disease and is important to note that not all substance use results in addictions, (SAMHSA & Office of the Surgeon General, 2016).

Figure 4. The Addiction Cycle

Drug addictions are categorized into 3 stages within the 'Addiction Cycle'; and are linked processes that involve seperate brain regions that can occur over the duration of months, weeks, days or multiple within singular days, as shown in Figure 4 (SAMHSA & Office of the Surgeon General, 2016).

Stage 1, (Binging/ Intoxication), involves the activation of habit and reward neuro-circuitry explaining compulsive drug seeking and intense cravings when the drug has involvement in the individuals environment, (SAMHSA & Office of the Surgeon General, 2016).

Stage 2, (Withdrawal), sets up the cycle of repeating stage 1 through withdrawal symptoms of negative emotions and physical illness with severity and longevity of symptoms dependent on severity and type of drug, (SAMHSA & Office of the Surgeon General, 2016).

Stage 3, (Preoccupation/ Anticipation), involves the disruption of executive functioning, and through various neuron processing, drives substance use for an individual through cravings, habit like seeking behaviours, and impulsive and compulsive seeking behaviours, (SAMHSA & Office of the Surgeon General, 2016).

Depressants

Depressants are a classification of drug that slow the signals between the brain and body, directly affecting concentration, coordination, response and speech, (DHDA, 2021). In small doses allowing the individual to feel more calm and relaxed as well as less inhibited, and in larger doses symptoms of tiredness, nausea, unconsciousness, loss of memory and in extreme cases, death, (DHDA, 2021). Unlike what the name may suggest, depressants are not always a direct cause of development or feelings of depression, (DHDA, 2021). Common examples of depressants include; alcohol, cannabis, GHB (gamma-hyrdoxbutrate), benzodiazepines, ketamine, and opioids (heroin, morphine and codeine), (DHDA, 2021).

Hallucinogen

Hallucinogens are a classification of drug with the ability to warp an individuals sense of reality, through hallucinations and distorting the 5 senses, (hearing, taste, smell, vision, and touch), (DHDA, 2021). Small doses of hallucinogens allow the individual to feel senses of floating, numbness, confusion, disorientation and dizziness, (DHDA, 2021). Larger doses may cause an individual to experience hallucinations, memory loss, anxiety/distress/paranoia, increased heart rate and aggression, (DHDA, 2021). Common examples of hallucinogens include cannabis, ketamine, LSD (lysergic acid diethylamide), magic mushrooms (psilocybin), and PCP (phencyclidine), (DHDA, 2021). Extreme long term use of cannabis is associated with health conditions such as chronic bronchitis, lung cancer, increased risk of stroke, exacerbation of mood and psychotic disorders, (such as anxiety and schizophrenia), and the exacerbation of neurogeneritive diseases, (such as Alzheimer's), (Sheikh & Dua, 2023).

Stimulants

Stimulants are the broad drug classification causing increased signals between the body and brain, often used for various reasons including performance enhancement, recreational use, especially in 'party' settings, and medical benefits, (Farzam, et al., 2023). Stimulants increase the amount of dopamine in the reward circuit that causes a 'euphoric high' through direct release of dopamine or restriction of the ability to remove dopamine from the synapses of the brain, (SAMHSA & Office of the Surgeon General, 2016). This is displayed through increased heart rate, temperature and blood pressure, reduction in appetite, agitation, sleeplessness, (DHDA, 2021). Small doses allow the individual to feel heightened confidence, alertness and energy, with larger doses placing the individual at risk of anxiety/panic, seizers, body cramping, paranoia and in extreme cases, death, (DHDA, 2021). Adverse effects of the drug are often dependant. Common examples of drugs classified as stimulants include; amphetamines, caffeine, cocaine, MDMA and nicotine, (DHDA, 2021).

Drug classifications direct impact on emotion regulation and relating abilities

Table 1. How varying drug classification can directly affect core components of ER, (Van Hedger, et al., 2021).

	Neurological occurrences	Emotional Responses Alteration
Depressants (Alcohol)	- Reduced activity within the amygdala, insula, and parahippocampal gyrus. - Increased activity in the nucleus accumbens.	- Long and short-term emotional blunting responses to negative stimuli. - Reduced ability in visual processing. - Increasing the rewarding effects of social stimuli.
Hallucinogens (Ketamine)	- Reduction in activity within the amygdala and hippocampus. - Decrease in activation of the right insula and pregenual anterior cingulate cortex.	- Altered conciseness and lack of response to language. - Reduces brain activation to negative emotional stimuli.
Stimulants (MDMA)	- Increased reactivity in the limbic and midbrain in response to negative emotional stimuli. - Increased reactivity in the limbic and midbrain to positive emotional stimuli. - Reduced amygdala activity to angry stimuli.	- Produces feelings of empathy and social connections. - Impairment in the ability to identify angry faces. - Enhancement of reactions to positive stimuli. - Inconsistent effects on emotional reactivity.

Drug usage effects on behaviour and the brain in effective emotion regulation

A systematic review on emotional regulation within substance use disorders indicates that individuals dealing with substance use disorders appear to have higher issues in emotional regulation, (Stellern et al., 2022). A study conducted by Zareban et al. (2017), investigated emotional difficulty variations between drug dependant and nondependent individual's. This study highlighted that whilst both groups struggled with emotional awareness, drug dependent individuals had higher difficulty in 5 key ares of ER; ER strategies, emotional clarity, nonacceptance of emotional responses, engagement of goal oriented behaviour, and impulse control (Zareban et al., 2017). Specific drug classifications and effects on ER are shown in Table 1.

Behavioural impacts of drug use

Engaging with substance is associated with high levels of emotional nonacceptance, experimental avoidance and increased efforts to detach from negative internal emotional states, with particular importance placed on individuals who may amplify these negative states (Gold et al, 2021).

Depressant drug use is linked to aggressive behaviour, unintentional injuries and self-inflicted injuries, (Anderson, Rehm, & Room, 2015, p. 1946). Alcohol will be used as an exemplar drug of behaviour caused from consumption. Alcohol consumption directly affects the serotonin and gamma-aminobutyric receptors, leading to a decrease in fear and general anxiety whilst risk taking increases, leaving little care for social, physical and legal consequences of actions, (Anderson, Rehm, & Room, 2015, p. 1946). Alcohol consumption has also been observed as a consistent association to decreased cognitive functioning such as decreases in problem solving abilities and increased emotional conflict situations, heightening emotional responses and instability (Anderson, Rehm, & Room, 2015, p. 1946). Observational studies have also highlighted association of alcohol and an increase in violence, intentional injury and self inflicting injuries, with experimental studies finding consumption of five or more standards a strong predictor of fighting possibilities (Anderson, Rehm, & Room, 2015, p. 1946). This is due to men in particular, having an increase in behaviour that demonstrates personal power and abilities, (Anderson, Rehm, & Room, 2015, p. 1946). As well as being the perpetrator of violence, consumption of alcohol also places individuals at risk of being the victim of violent attacks and assaults, as being under the influence may make them an 'easy target', (Anderson, Rehm, & Room, 2015, p. 1946).

Neurobiological impacts of drug use

Figure 4. Some brain regions that are affected by substance abuse.

Substance use causes changes in the prolonging, structural and functioning of the brain known as neuroadaptations, that are persistent after use completes, and particularly impacts three main regions as shown in Figure 4, including the basal ganglia, the extended amygdala and the prefrontal cortex, (SAMHSA & Office of the Surgeon General, 2016). Understanding the neurological affects of substance use guide understanding of ongoing issues associated with ER. Table 2 covers the specific neurology associated with drug abuse within the addiction cycle.

Table 2. Neurobiological affects of ongoing substance use (SAMHSA & Office of the Surgeon General, 2016).

	Neurological Affect
Stage 1	- Substances abused for extended periods cause dysfunction within the dopamine reward system, (the basal ganglia and extended amygdala). - 'Reward effects' felt through substance use can be seen through brain imaging, being a result of the nucleus accumbens activation of dopamine and opioid signalling systems. - Dopamine and glutamate are released, and the opioid system is activated within the brain. Activation and neuron changes occur within the dorsal striatum, leading to habit formation involved in ongoing drug use.
Stage 2	- Extended substance use causes dysfunction within the brain's dopamine reward system, involving activity from both the basal ganglia and extended amygdala. - D2 dopamine receptors had a significant decrease in comparison to individuals who have not used substances due to withdrawal from substances. - Activation of stress neurotransmitters, including corticotropin-releasing factor, norepinephrine and dynorphin, is associated with negative emotions linked to withdrawal and stress, causing motivation and compulsions of re-use to stop negative emotions.
Stage 3	- When individuals seek out substances and receive environmental cues associated with substance use, the prefrontal cortex activity increases, stimulating the nucleus accumbens to release glutamate. - Glutamate drives ongoing substance use through increasing craving and disruption of dopamine.

Conclusion

Emotional states and ER impact on everyday life functioning, increasing an individual's ability to cope with stress, identify, adapt and manage emotions. ER achieves these goals based on attentional, cognitive, behavioural, social and biological actions. Drug use has a significant impact on emotional state and is therefore often used by individuals as emotional regulation. Drug use as ER often begins through negative stimuli presented in stressful early life environments, genetic variants and pre-existing mental health disorders. Using drugs as ER may cause susceptibility to addiction, as well as altering behavioural and neurological states. These effects continue to impact further ongoing drug use and the overall ability to have healthy and adaptable ER skills.

See also

• Cocaine and emotional regulation (Book chapter, 2020).
• Emotional self-regulation (Wikipedia)

References

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Sheikh, N. K., & Dua, A. (2023. Cannabinoids. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556062/

Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130. https://doi.org/10.1196/annals.1441.030

Stellern, J., Xiao, K. B., Grennell, E., Sanches, M., Gowin, J. L., & Sloan, M. E. (2023). Emotion regulation in substance use disorders: a systematic review and meta-analysis. Addiction (Abingdon, England), 118(1), 30–47. https://doi.org/10.1111/add.16001

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Van Hedger, K., Mayo, L. M., Bershad, A. K., Madray, R., & de Wit, H. (2021). Effects of Acute Drug Administration on Emotion: A Review of Pharmacological MRI Studies. Current addiction reports, 8(2), 181–193. https://doi.org/10.1007/s40429-021-00362-y

Wong, C. F., Silva, K., Kecojevic, A., Schrager, S. M., Bloom, J. J., Iverson, E., & Lankenau, S. E. (2013). Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults. Drug and Alcohol Dependence, 132(1–2), 165–171. https://doi.org/10.1016/j.drugalcdep.2013.01.024

Zareban, I., Bakhshani, N., Bor, M., & Bakhshani, S. (2017). Emotion regulation difficulties in drug abusers. Annals of Tropical Medicine and Public Health, 10(6). https://doi.org/10.4103/ATMPH.ATMPH_617_17

External links

• Meta-analysis and systematic review of emotional regulation in substance use disorders (Stellern et al., 2023).