Why Someone's "Drug of Choice" Matters

"When people jokingly say they have a "drug of choice," they're implying a particular substance matches their emotional and psychological needs. They don't realize they're right: There are drugs of choice for individuals, and there's a reason for preferring certain drugs. Clinicians and researchers have long recognized that drug preference isn't random. The drug of choice may reveal how a person's psychiatric vulnerabilities, life experiences, and personality style interact to affect self-medication and temporary equilibrium."

"Most individuals with substance use disorders (SUDs) have tried multiple drugs and, over time, settled into one or two that "fit." This fit often mirrors underlying psychiatric issues and personal neurochemistry. Someone suffering from chronic anxiety may gravitate toward alcohol, benzodiazepines, or opioids-substances that initially quiet internal tension. In contrast, a person with low-energy depression may prefer cocaine or amphetamines, which transiently restore energy, drive, and confidence."

"All addictive substances share a final common pathway, increasing dopamine transmission in the mesolimbic system. Yet the manner by which a drug achieves this increased dopamine differs, and that difference helps determine preference. Alcohol, benzodiazepines, and opioids calm down an overactive limbic system, while stimulants (cocaine, amphetamine) create enthusiasm and alertness. Cannabis acts through the endocannabinoid system, modulating mood and anxiety. Each drug addresses a different imbalance-whether hyperarousal, anhedonia, or psychic pain."

Drug preference reflects interactions among psychiatric vulnerabilities, life experiences, personality style, and neurochemistry, producing a felt fit with one or two substances. Many people with substance use disorders try multiple drugs before settling on those that regulate their predominant symptoms. Chronic anxiety commonly leads to alcohol, benzodiazepines, or opioids that reduce internal tension, while low-energy depression often leads to stimulants that restore energy and confidence. Early drug experiences condition expectations and reinforce use when relief or social connection occurs. All addictive substances ultimately increase mesolimbic dopamine, but different drugs act through distinct mechanisms to address varied imbalances.

Read at Psychology Today