Self-harm is, unfortunately, an incredibly taboo subject that is rarely openly discussed due to a lack of understanding and the feelings of shame and guilt in those that suffer from it. It is not, by itself, classified as a mental health disorder and is usually considered more of a symptom of other diagnoses, which makes self-harm a dangerous and difficult behavior to treat. Most people that engage in self-injurious behavior do so as a way to release intense emotion, create emotion when they are feeling numb, give themselves a sense of control, or as a method of self-punishment. A substance use disorder and self-harm often co-occur, whether the person struggling utilized self-jury before they turned to substances or it developed as the disease progressed. In these cases, as the two issues can negatively compound one another, it’s important to treat both the symptom and the disorder.

The Why Behind the Harm

When the motivation behind self-harming behavior is better understood it can lead to a clearer path of treatment. Connecting the dots can help best find a path to recovery both from a coping mechanism that can become more dangerous over time, and the mental health struggles that might have necessitated it. In a closer examination of the common motivation for those that self-harm, symptoms of substance use disorders exist throughout. The person that struggles with substance use disorder may find self-harm to be an exceptionally effective tool for coping with their illness, as abstinence is typically not an option until treatment is sought.

• Calming turbulent emotions – For some, the act of self-harm has the ability to relieve intense emotional pain. People affected by certain mental health issues can experience extreme emotion that feels unbearable in the moment. The act of cutting or other self-injurious behavior creates a sense of calm from these emotions, a physical outlet for overwhelming emotional distress. Those with a substance use disorder often struggle to emotionally regulate and may begin to self-harm as a way to self-soothe through turmoil.
• Craving more than emptiness – People who struggle with certain types of trauma or mental illness often disassociate from their surroundings without much ability to control this response. Feeling detached can be isolating and painful; and in these cases, people use self-harm as a type of tool to bring about feeling. Functioning almost as a grounding technique, the intense physical pain has the ability to reconnect them to their present surroundings and feelings. Substances have the ability to assist in numbing emotions. While this may have originally been the desired effect, as using becomes compulsive, those with substance use disorders become habitually numb. In order to bring about feeling, without the ability to stop using, self-harm can become a tool.
• Something that can be “controlled” – Self-harm can be one thing that a person can control in a situation where they otherwise feel powerless. For someone that has developed this coping mechanism, when things outside their control create intense stress, self-harm is one they have the ability to obtain control. For those specifically suffering from a substance use disorder, when someone feels as if they have lost control of their using, self-harm can provide a way to exercise control in some way.
• Self-punishment – A possible long term effect on those who have been victims of abuse is to absorb the perspective of their abuser into their own inner narrative. This can lead to thoughts where one feels the need to punish themselves in the same way their abuser did, and self-harm provides that for them. Outside of an ingrained need for punishment, those who struggle with substance use disorders might turn to self-harming behaviors to alleviate the shame and guilt they feel as a result of their illness. As many as two-thirds of those that receive treatment for substance use issues report having experienced abuse as children. Those with both of these motivating factors have a high potential to engage in self-harm.

Treating the Symptom Amidst Treating the Disorder

Generally, those that engage in self-injurious behaviors do not have a wish to die or engage in suicidal behaviors; though it is possible that suicidal thoughts can be increased by self-harm over time. Due to the possibility of increased risk in addition to the inherent dangers involved with self-injury, it’s important to treat this behavior, even while seeking treatment of an underlying issue. Typically, focused therapy is needed to help teach someone to recognize the compulsion and have awareness around their motives for self-harm. Cognitive behavioral therapy is useful in retraining the mind to seek healthier ways of coping with emotional upheaval, trauma, and feelings of emptiness. Grounding techniques can be learned and implemented to be used once there is an awareness of those situations that may be triggering. If someone is struggling with these behaviors in addition to or as a result of a substance use disorder, treatment should be sought for both. Skills learned in treatment and 12-Step programs can help treat the symptoms of a substance use disorder that may have created opportunities where it felt necessary to self-harm. If recovery from both is actively sought, there can be freedom from not only self-damaging behaviors but also the negative thoughts and emotions that they seek to alleviate.

Ashley Addiction Treatment is an innovative treatment program located on Maryland’s Chesapeake Bay. Ashley provides support for professionals seeking help with addiction. We are able to help people with co-occurring disorders and offer confidential treatment programs to meet your needs. Please reach out to us today at 800-799-4673.