Is Self-Harm an Addiction? What Is the Role of Alcohol in It?

In Girl in Pieces, Kathleen Glasgow writes: “I just want to feel better. My own body is my deepest enemy. It wants, it wants, it wants and when it does not get, it cries and cries and I punish it. How can you live in fear of your own body?”

And yet, so many people develop a painful relationship with what should, in theory, be our closest friend and ally — our own body. Self-harm is, unfortunately, very common and affects people across the globe. But what is it exactly? Is self-harm an addiction? And what is its relationship to alcohol?

What Is Self-Harm?

The psychology behind self-harm can be complicated, but it comes down to this: it’s an attempt to feel emotional relief through inflicting physical pain on ourselves. It might seem counterintuitive to an outside observer, but at its heart, self-harm is usually a way to overcome overwhelming emotional distress.

While self-harm can consist of any infliction of pain or injury, there are some common patterns, according to SAMHSA:

• Some people might cut or pierce their skin with a sharp object. 
• Others might punch hard things, such as a wall or bed post.
• Burning oneself with a match, cigarette, or candle is another typical form of self-injury.
• Some might even go so far as to break bones, causing severe physical damage and pain.

It’s important to note that there’s a big difference between self-harm and suicidal behavior: the intent is not to end one’s life but rather to find some relief from (what seems at the moment like) an insurmountable emotional obstacle.

Self-Harm Facts and Statistics

While self-harm looks different in each individual case, there are some patterns that scientists and medical professionals have noted over the years. Here’s an overview:

• Young people are at greater risk. Self harm — or “nonsuicidal self-injury” (NSSI) is far more common among adolescents and young adults. Studies show that as much as 15% to 20% of this population is affected, with the typical age of onset hovering around 13 or 14. Sadly, however, even younger populations are affected. One study found that as much as 7.6% of third-graders, 4% of sixth-graders, and 12.7% of ninth-graders admitted to engaging in NSSI at some point.
• Men and women self-harm at similar rates. There’s a cultural assumption out there that says women self-harm more than men. However, this is a bit of a myth — studies show that both genders are equally susceptible, but women are more likely to report certain types of self-harm (especially cutting). Men, on the other hand, are more likely to use methods such as hitting or burning and are less likely to report it.
• People with other mental health challenges are more vulnerable. If we’re struggling with depression, anxiety, and mood disorders, we’re at greater risk — no matter how old we are. It’s especially common in people who are prone to self-criticism and tend to have more self-directed negative emotions. 
• Self-harm is a global problem. In general, the rates are roughly the same across the world, with similar demographic patterns appearing in different countries. Self-harm doesn’t occur in just one region or area. It is a global problem.

Is Self-Harm an Addiction?

People might describe self-harm as “addictive,” but is it really a true “addiction”? The answer is complex. While self-harm isn’t classified as an addiction by doctors, it does share some common features with substance misuse and addictive behaviors. Here’s an overview:

• Self-harm is driven by urges. Just like many addictions, self-harm is driven by urges — strong compulsions to engage in a behavior. 
• It’s often followed by a sense of relief. The relief people feel after engaging in self-harm can even reach the level of euphoria. Of course, we must remember that the relief is illusory — it doesn’t solve the underlying cause of distress that leads us to seek out a way to cope, and often the problems only multiply as a result.
• A vicious cycle starts to form. Self-harm might provide a temporary illusion of relief, but we’re likely to feel worse when the initial euphoria wears off. And if we routinely turn to this behavior in times of stress, we may find ourselves using it more and more frequently and end up in a vicious cycle.
• Dopamine plays an important role. Dopamine, a neurotransmitter often dubbed the "feel-good" chemical, plays a significant role in the brain's reward system. Engaging in self-harm may lead to a temporary surge of dopamine. It delivers a brief mood lift or emotional reprieve, which reinforces the behavior and makes it hard to stop, leading to a pattern of behavior.

We’ll return to the role of dopamine in self-harm a bit later when we talk about its connection with alcohol use. For now, let’s get a bit more acquainted with the emotional landscape around self-harm and look at the reasons why people might choose to self-harm. 

Why Is Self-Harm Addictive?

What is it that prompts us to go against the natural instinct to take care of our bodies and shield ourselves from pain? The reality is, any intense emotion — fear, anger, self-doubt, embarrassment, and so forth — can serve as a trigger. Once we discover a quick way to feel relief from whatever troubles us, it’s easy for that behavior to become a “quick-fix solution” to our problems, even when doing so isn’t in our best interests. As Caroline Kettlewell writes in Skin Game:

You might imagine that a person would resort to self-mutilation only under extremes of duress, but once I'd crossed that line the first time, taken that fateful step off the precipice, then almost any reason was a good enough reason, almost any provocation was provocation enough. Cutting was my all-purpose solution.

As far as science is concerned, there are a few common emotional triggers that lead people to self-injure. From an NCBI article “Why do people self-injure?”:

• Most people self-harm in response to emotional pain. Research shows that “overwhelming negative emotion” almost always precedes NSSI: “First, by a wide margin, NSSI most commonly functions to (temporarily) alleviate overwhelming negative emotion.” Strong negative emotions usually precede the behavior, which provides an illusory and short-lived sense of much-needed relief. 
• Some people self-injure as a form of self-punishment. Those of us prone to self-criticism are especially likely to vent our frustrations about our perceived flaws or inadequacies in this way. 
• Some may be trying to elicit an effect in others. While less common than other reasons, sometimes a desire to elicit a response from others could be behind NSSI. It’s important to understand that these situations call for just as much empathy as the others — they’re often a desperate cry for help. 

In the end, the reasons behind NSSI will always be deeply personal and might vary. Regardless of what drives the impulse, it’s essential to be kind to ourselves and realize that there’s no shame in asking for help. There are many caring folks out there who have been where you are and know what it’s like. Don’t lose hope!

Self-Harm and Alcohol

Finally, there’s the question of self-harm, alcohol, and other forms of substance misuse. Is there a direct link between them? Do they tend to occur together? Research says that they can — for a number of reasons. Let’s take a closer look.

Alcohol Misuse and Self-Harm Can Share Similar Triggers

For one thing, the same reasons that drive us to self-harm can trigger alcohol misuse. Self-harm often co-occurs with other addictions, such as substance abuse, gambling, or eating disorders. This overlap might be due to underlying issues such as anxiety, depression, or trauma, which drive both self-harm and other addictive behaviors. The use of multiple coping mechanisms can make them tricky to untangle, but it’s crucial to do so in order to get better. Occasionally, addictions might “take turns” as we turn to one and then switch to another. This phenomenon is known as “transfer addictions” — to find out more, check out “What Are Transfer Addictions? Examining the Science.”

Alcohol’s Effects Make Self-Harm More Likely

Research shows that people are more likely to self-harm while drinking. In fact, alcohol was a factor in 21% of self-harm cases, according to one study. There are a few reasons why the two often go together:

• Alcohol has disinhibiting effects. You know how we say and do things we normally wouldn’t after a few drinks? While sometimes the result is merely embarrassing (all those late-night texts or boozy messages we cringe over the next morning), unfortunately disinhibition can lead us down some dark paths. The reason has to do with the fact that alcohol temporarily slows down activity in the prefrontal cortex, the rational hub of the brain in charge of self-control and reason. Without the checks and balances that normally keep us safe, our impulses — including the impulse to self-harm — tend to run wild.
• Alcohol is a depressant. Although the initial dopamine rush we get from alcohol might make us feel good, it’s ultimately a downer (in every sense of the word). It dulls our senses, and, after that initial rush, leads to a rebound effect that can leave us feeling down in the dumps. The result? We’re more likely to act on those sad feelings.

As we can see, alcohol’s effects on mood make it a particularly dangerous “partner in crime.” We’re more likely to self-harm when drunk. We are also more likely to experience urges to self-harm because of alcohol’s effects on our mental and emotional state. 

But there’s more to the story. Let’s take a deeper look at the dopamine-driven reward system that drives our habits.

The Same Brain Mechanisms Are Involved in Alcohol Misuse and Self-Harm

As you can see, there are overlapping mechanisms involved in self-harm and alcohol misuse, so the two can be self-reinforcing. Alcohol misuse is driven by dopamine — the reward neurotransmitter that plays an essential role in habit formation and learning. The brain loves habits and keeps them alive through dopamine surges that create feelings of pleasure. There’s an evolutionary reason behind this system: the neurological “reward” is meant to keep us alive by encouraging habits that increase our chances of survival, such as eating, socializing, and finding romantic partners. 

Unfortunately, this system can be hijacked by not-so-healthy activities and substances such as alcohol and other drugs. Given that both alcohol and self-harm trigger dopamine release, it’s no wonder the two tend to egg each other on, so to speak. The greater the dopamine boost, the “stickier” the habit — in this case, with tragic results.

Self-Harm Recovery

Recovery from self-harm involves addressing both the behavior itself and its root causes. 

• Therapy can be a lifeline. These days, therapy is highly individualized and many methods beyond traditional talk therapy are available. For self-harm and alcohol misuse in particular, cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), can work wonders when it comes to uncovering thought distortions, changing thought patterns, and developing healthy coping mechanisms.
• We also need support from family and friends along the way. Support groups and sometimes medications are also used to treat underlying mental health conditions. Recovery is a gradual process of learning to manage emotions and stress in healthier ways and building resilience against the impulses to harm oneself.

And remember, Reframe is here to help you every step of the way. Our thriving community of folks just like you who have struggled with similar issues and have found a way out are more than happy to support you, offer an empathetic ear, and share their stories.

Summing Up

In the end, the journey to recovery might be a challenging one, but it’s a testament to our strength. As Cheryl Rainfield writes in Scars: 

Other times, I look at my scars and see something else: a girl who was trying to cope with something horrible that she should never have had to live through at all. My scars show pain and suffering, but they also show my will to survive. They're part of my history that'll always be there.

Many of us struggle with what seem like impossible situations and difficulties, but rest assured, there’s a way out. We believe in you!