Self-Harm and Addiction

Self-harm is a serious sign of mental distress and needs urgent attention from doctors or therapists. If someone is also dealing with addiction, this further necessitates the need for medical care. Getting the right help is crucial to tackling both the urge to harm oneself and the addiction. This page focuses on self-harm and addiction, as well as offers advice on how to get help.

What is self-harm?

Self-harm involves deliberately causing harm or injury to oneself, often as a way to manage or express emotional pain and distress or to cope with overwhelming feelings. It encompasses a range of methods through which people might inflict harm upon themselves. Self-harming behaviour is a significant concern, signalling deeper emotional or psychological issues that necessitate care and support.

Non-Suicidal Self-Injury (NSSI)

NSSI refers to the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned.

It’s important to reiterate that while NSSI is a harmful coping mechanism, it is not always intended as a suicide attempt but rather an unhealthy way to manage emotional pain. Below are some of the most common behaviours related to NSSI:

  • Cutting: Making cuts on one’s body with sharp objects, such as knives or razor blades. This is one of the most common forms of NSSI.
  • Burning: Applying heat or friction to one’s own skin to cause burns. This can be done with lighters, matches, or other hot objects.
  • Scratching: Severely scratching oneself to the point of breaking the skin. This can result in bleeding and significant injury.
  • Punching or hitting oneself: Engaging in behaviours where one might punch their own body or hit themselves with objects to cause bruising or other injuries.
  • Biting: Biting oneself to the extent that it breaks the skin and causes injury.
  • Hair-pulling: Also known as trichotillomania, this involves pulling out one’s own hair. An irresistible urge often drives it and can result in noticeable hair loss.
  • Interfering with wound healing: Deliberately preventing wounds from healing, either by picking at scabs or reopening wounds.
  • Inserting objects into the body: Self-insertion of objects under the skin or into body openings without medical reasons.
  • Skin carving: Etching or carving words or symbols into the skin with sharp objects.
  • Extreme nail-biting: Biting the nails to the extent that it causes injury to the nail beds or fingers.

What causes people to consider self-harming?

The action of self-harm is a complex behaviour that people may engage in for various reasons. Understanding these reasons is crucial for providing appropriate support and intervention. Here are some of the key motivations behind self-harm:

A cry for help or to release bottled-up feelings
Many people who engage in self-harm do so as a way to express deep emotional pain or distress that they feel unable to communicate in other ways. Self-harming can be a means of externalising what cannot be verbally expressed, serving as a physical manifestation of internal suffering. It can also signal people’s need for help or support from others.
Some people may self-harm as a form of self-punishment. This can be due to feelings of guilt, shame, or unworthiness, where the person believes they deserve to be punished for their perceived faults or mistakes. This self-directed aggression can be a reflection of harsh self-criticism or internalised negative beliefs about oneself.
Turning aggression inwards
In situations where expressing anger or aggression towards others is not possible or socially acceptable, some people might direct this aggression towards themselves through self-harm. This can be a way of managing or controlling feelings of anger without externalising them towards others, which they might see as unacceptable or fear could lead to negative consequences.
For some, self-harm is a means to feel something, especially if they experience emotional numbness or dissociation. The physical pain of self-injury can serve as a way to break through feelings of emptiness or disconnection, making the individual feel more alive or present in the moment. It can temporarily alleviate feelings of numbness or detachment from reality.
Attaining a sense of control and mastery
In the face of situations or emotions that feel overwhelming or uncontrollable, self-harming can provide a sense of control. The act of choosing when, where, and how to inflict harm can give people a feeling of mastery over their bodies and their pain, in contrast to the helplessness they might feel regarding other aspects of their lives.

While the reasons mentioned offer insight into why people might engage in self-harm, they don’t fully capture the complexity of this behaviour. Most cases of self-harm indicate an unhealthy management of negative emotional states. It’s often a symptom of deeper psychological issues, such as depression, anxiety, or trauma. Self-harm provides temporary relief or control but doesn’t address the root causes of distress, highlighting the need for supportive interventions and healthier coping mechanisms.

The link between addiction and self-harm

In a 2019 study, it was discovered that 32.7% of patients with pre-existing substance use disorders engaged in self-harm. Another study revealed that 27.8% of people receiving treatment for drug or alcohol addiction at a treatment centre had previously engaged in cutting themselves (without the intention of suicide). Additionally, 22.2% had severely scratched themselves to the point of bleeding or scarring, 22.2% had used chemicals to scrub their skin, and another 22.2% had punched themselves until bruising appeared. The remaining participants reported engaging in other forms of self-harm.

Regrettably, these findings are not isolated, with numerous studies demonstrating the link between addiction and self-harm.

This raises the complex question of whether self-harm develops as a result of addiction or if it precedes it. Although there is no definitive answer, it is evident that both can influence each other.

What comes first – self-harm or addiction?

Addiction can lead to self-harm as people may use physical pain as a means to cope with the emotional and psychological distress caused by their substance use disorder. The cycle of addiction often brings about feelings of guilt, shame, and hopelessness, which can overwhelm an individual’s coping mechanisms. In an attempt to escape these negative emotions or to exert some control over their life, a person might turn to self-harm as a form of relief or punishment.

Conversely, self-harm could lead to addiction when people seek substances to numb the pain or emotional turmoil that drives their self-injurious behaviour. Substance use may begin as a way to cope with the immediate aftermath of self-harm or to escape from underlying issues contributing to the behaviour, such as trauma, depression, or anxiety.

Over time, this can develop into a substance use disorder, as the individual becomes increasingly reliant on drugs or alcohol to manage their emotions, and the cycle of self-harm and substance use perpetuates itself.

Both pathways illustrate the complex interrelationship between self-harm and addiction, each potentially serving as both a cause and a consequence of the other, trapping people in a vicious cycle that is challenging to break.

Getting help for self-harm and addiction at Sanctuary Lodge

Before starting addiction treatment, it’s essential to manage any self-harm behaviours to improve the chances of a positive recovery journey. This process includes seeking guidance from a mental health expert, getting prescriptions for any needed medications, and engaging in therapy aimed at addressing self-harm either before or concurrently with addiction treatment.

The medications that might be prescribed can vary and include antidepressants, mood stabilisers, or anti-anxiety medications, based on what’s driving the self-harm actions. Upon joining a rehabilitation programme at Sanctuary Lodge, our healthcare team will ensure that you have access to your prescribed medications and offer extra support when necessary.

Our treatment programme

At Sanctuary Lodge, our rehabilitation services are designed to combat addiction while providing crucial support for maintaining sobriety. Significantly, the therapeutic methods employed in our treatment programmes can also positively impact self-harm behaviours. This benefit stems from the development of coping mechanisms and supportive communities during rehab, which are particularly helpful for those prone to self-harm.

Our treatment plans at Sanctuary Lodge include a range of therapies that are beneficial for those facing both addiction and self-harm, such as:

  • Dialectical Behavioural Therapy (DBT): This therapy is specifically aimed at people exhibiting self-destructive behaviours as well as those with addictions. DBT helps you build skills to manage emotional distress more effectively.
  • Mindfulness-based therapies: These therapies focus on cultivating a non-judgmental awareness of your thoughts and emotions. By helping you recognise the triggers that lead to substance abuse and self-harm, these therapies encourage a mindful observation of distress without resorting to harmful behaviours.
  • Group therapy: By forming a community of people facing similar issues, group therapy offers valuable support for those diagnosed with both self-harm and addiction. This environment allows for the sharing and learning of effective strategies for controlling destructive urges while also providing a sense of belonging and mutual support on the journey towards recovery.
  • Aftercare: Our support at Sanctuary Lodge extends beyond the initial rehab phase, with a comprehensive aftercare programme designed to facilitate ongoing recovery from both self-harm and addiction. This includes continuous counselling, regular follow-ups, and involvement in support groups, along with workshops and resources to aid in managing both conditions. Family involvement is also encouraged to bolster the support network essential for successful reintegration into everyday life after rehab.

What comes next?

At Sanctuary Lodge, we understand the unique challenges that self-harm presents during the journey to addiction recovery. We are dedicated to creating detailed and empathetic treatment programmes that provide holistic support. If you or someone close to you is struggling with self-harm and addiction, don’t hesitate. Reach out to Sanctuary Lodge now, and let us help you take the first steps towards a brighter, healthier future.

(Click here to see works cited)

  • American Psychiatric Association, DSM-5 Task Force. 2013. Diagnostic and statistical manual of mental disorders: DSM-5™ 5th ed. American Psychiatric Publishing, Inc..
  • Shahwan S, Zhang Y, Sambasivam R, Ong SH, Chong SA, Subramaniam M. A qualitative study of motivations for non-suicidal self-injury in a sample of psychiatric outpatients in Singapore. Singapore Med J. 2022;63(12):723-730. doi:10.11622/smedj.2021161
  • Gupta R, Narnoli S, Das N, Sarkar S, Balhara YPS. Patterns and predictors of self-harm in patients with substance-use disorder. Indian J Psychiatry. 2019;61(5):431-438. doi:10.4103/psychiatry.IndianJPsychiatry_578_18
  • Gratz KL, Tull MT. The Relationship Between Emotion Dysregulation and Deliberate Self-Harm Among Inpatients with Substance Use Disorders. Cognit Ther Res. 2010;34(6):544-553. doi:10.1007/s10608-009-9268-4
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