Addiction, Dependency, Coping, and Self-Medicating: What Are You Actually Coping With?

At Nightingale, we find it useful to think about addiction alongside a broader set of concepts—coping, dependency, adaptation, compulsivity, and self-medication—because these distinctions can help us understand what is actually happening rather than simply applying a label to the behaviour.

Coping

Coping is ordinary. We are all constantly finding ways to navigate difficult experiences, regulate ourselves, solve problems, and maintain some kind of equilibrium. Coping can take almost infinite forms because people have different histories, needs, bodies, predilections, tastes, aesthetics, and problems to solve.

Someone who can't quiet their mind might discover that running every day helps. They may not think of running as a coping strategy because it looks healthy, doesn't feel like a strategy, and perhaps the underlying problem of having an unusually active mind isn't even recognized as a problem. But psychologically, we can still trace a relationship between the difficulty and the behaviour.

Adaptive and Maladaptive Coping

Not all coping is good or bad in itself. A coping strategy can be adaptive when it helps a person navigate a difficulty without creating disproportionate problems elsewhere.

Our runner might be using exercise to settle an unquiet mind, and that might be an excellent solution. Unless, of course, the running distances start getting completely out of control—which can happen, for example, in some corners of the ultra-running world.

Dependency

Everyday life is full of dependencies. Our Vancouver clients might depend on a certain amount of conversation, a few cups of tea or coffee, regular exercise, quiet time, sleep, particular routines, or contact with certain people. We would not normally call these addictions. They are simply part of how a person keeps themselves in equilibrium.

Dependency, in this broader sense, simply means that something has become important to the way we function; it does not automatically mean that something is unhealthy, pathological, or addictive.

Addiction

Addiction is a narrower and more consequential concept. We often use the word for patterns in which a substance or behaviour has become particularly difficult to control and continues despite meaningful consequences.

But even here, there is a great deal of cultural meaning wrapped up in the label. We tend to call some things addictions and other things ordinary dependencies, and those judgments are not always as objective as they appear.

Bruce Alexander's work on addiction, including the famous Rat Park experiments, helped draw attention to the importance of environment and social context in understanding addictive behaviour. The larger lesson is useful: what we call an addiction is not simply a property of a substance or behaviour in isolation.

Consequential

One useful distinction is between a behaviour being unusual and being consequential. A person can have a highly unusual routine that causes very little difficulty in their life. Another person can have a completely ordinary behaviour that has become costly because of how frequently, intensely, or compulsively they engage in it.

Culturally Ascribed

What we call a dependency or addiction is also partly shaped by culture. Some dependencies are culturally sanctioned and even celebrated. Coffee, exercise, productivity, work, dieting, and financial discipline can all become highly organized parts of a person's identity without anyone necessarily describing them as compulsive.

Other behaviours are much more readily given the language of addiction. This doesn't mean that all addictions are simply cultural inventions; rather, it means that the labels we use sit within a larger social system of meanings about what counts as normal, healthy, excessive, or problematic.

Compulsivity

The more clinically interesting question is often whether a behaviour remains chosen. A person may consciously or unconsciously use a behaviour to navigate a difficulty in living. They discover that it works, repeat it, and eventually find that the behaviour has become increasingly reliable, automatic, and difficult to choose against.

Compulsivity can develop around many different behaviours, and a compulsive behaviour may or may not eventually produce a dependency.

Self-Medicating

This is where the term self-medicating becomes useful. It places substance use in the larger family of human attempts to alter an unwanted internal state.

Imagine our person with the unquiet mind again: running might help them reach a state of calm, but it requires shoes, training, physical health, time, and perhaps the ability to spend an hour moving along the seawall at a five-minute-per-kilometre pace. Someone without those resources might discover that a substance can produce a similar state of mind much more quickly.

Some maladaptive coping strategies are compelling precisely because they are cheap, powerful, and immediately available.

What Are You Actually Coping With?

The problem isn't that a person is trying to solve their problem. That's legitimate work. The more difficult, and perhaps interesting question is whether the strategy they have found is still serving them, whether it has become compulsive, and what problem it was originally recruited to solve.

Sometimes the most useful work isn't simply becoming better at resisting the coping behaviour; it is understanding the difficulty underneath it.

If someone has an unquiet mind, for example, it may be useful to develop better ways of calming themselves. But it may be even more useful to understand why their mind is so difficult to quiet in the first place. That may be the larger clinical opportunity.

Dependencies are part of life. Coping is ordinary. Some coping strategies are adaptive, some are maladaptive, some are consequential, and some become compulsive.

At Nightingale, addiction counselling is ultimately interested in helping people develop more freedom to choose between these strategies—and, where possible, to address the underlying problem so thoroughly that they don't need quite so much coping in the first place.