Drug use and suicide

In the previous post it was suggested that what has been called a gambling addiction may not an addiction. It certainly is different from what would be called a drug addiction. Whilst in the act of gambling the personality is not transformed like it is with taking drugs. With drugs the Parent and Adult ego states are rendered null and void which could be seen to constitute a major personality change. With gambling this does not happen.

Instead repetitive gambling could be seen as more as what is known as the defence mechanism of regression. The person responds to stress by engaging in behaviour where they end up in a child like position such that someone else has to take over for them to cope. Whilst this happens with some drug takers there are those where it does not happen for instance with many recreational users and what are known as functional alcoholics.


The point at hand here questions the definition of addiction. Those people who feel a compulsion to engage in a piece of behaviour that they find very hard to resist. With some discussion it becomes apparent that there are many differing reasons why that compulsion may exist. This would seem to be important to articulate because the way of treating such an addiction could vary considerably than if they are all assumed to be of a similar nature. As mentioned above if this thing that have been called a “gambling addiction” is actually more of a defence mechanism than an addiction how one deals with it will vary. Another example of this is described below.

There are a group of people who use drugs, some of them in a habitual and addictive way that are different and separate from the mainstream type of drug addict. Drug use in this group is more of a suicide attempt than drug use in the usual sense of the word.


The suicidal person has made one of seven suicide decisions:

If you don’t change I will kill myself
If things get too bad I will kill myself
I will show you even if it kills me
I will get you to kill me
I will kill myself by accident
I will almost die (over and over) to get you to love me
I will kill myself to hurt you

To summarise, some people have the ability to be able to take their own life if things get too bad or to hit back at someone and so forth. These people can imagine killing self, they have it in their behavioural repertoire to do such a thing.

For example
If you don’t change I will kill myself
If things get too bad I will kill myself
I will kill myself to hurt you

Some people do not have that. They cannot conceptualise of planning a suicide attempt, obtaining the items necessary and going through by acting out the plan. It is simply something beyond their imagination. However these people may still have made the suicide decision and thus they need to achieve it some other way.

For example
I will get you to kill me

These suicidal people can get others to kill them such as ‘Death by cop’ where the person behaves in such a threatening way to the police that they shoot him dead. They can voluntarily enter into a war zone and behave in such a way that the enemy kills them, or they can behave in such a way in a country that has the death penalty where the state kills them. The suicidal act is carried out by someone else.



Or there is another decision:
I will kill myself by accident

This person engages repetitively and voluntarily in high risk behaviour. This is where the line between accident and suicide gets blurry.


Some behaviour is a bit of both, an accident and a suicide and you can’t clearly distinguish between the two. This can include dangerous sports, driving cars at high speed (Peter Brock), working with dangerous animals (Steve Irwin), working in high risk occupations and also dangerous drug taking.

The type of drug taken and the method of ingestion can vary enormously. Smoking marijuana is quite safe compared to injecting heroin which is much more dangerous. If the person has had a few over doses where they were getting closer to the point of death then one could begin to diagnose that the drug taking has a suicidal motive underlying it. Alternatively one can do a life script analysis and ascertain if such a suicide decision exists in the person’s psyche.

If this is the case then there are significant treatment implications. Why would one work with a drug user to identifying the triggers for use, do motivational interviewing or work on relapse prevention with some one who could easily die a month or two latter by and ‘accidental suicide’ in a car accident.

In these circumstances they are suicidal first and a drug taker second and ones treatment plan would need to reflect this.

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Gambling addiction and regression

In the previous post I talked about drug users and how some of them could have a child like quality because drugs are an efficient and effective way for a person to regress. Most alcohol and drugs will remove the Parent and Adult ego states to varying degrees thus leaving the person in a child like state.

Any person prone to regression in the sense of using the defence mechanism of regression could be seen to be a potential problem drug user for the reasons just described. However even when not intoxicated often such people will still have a child like quality in the sense of being irresponsible, some times unemployed, perhaps endlessly sick or perhaps incapacitated by some form of physical or psychological illness and establishing relationships with others who tend to take the parental role.



A good example of this regressed quality in relationships comes with the addicted gambler. These people could be seen as being financially irresponsible. They do not know how to manage their finances. From a psychological point of view I would see gambling addicts as no different from the person who mismanages money by accruing large credit card debt or investing in dodgy business deals where they end up broke and in debt. A person who ends up broke from share trading is no different from a gambling addict at least in the psychological sense.

They both end up in a child like position or in a state of regression in this way. A young child does not know how to manage its money and if left to its own devices will end up in financial trouble. Thus it has a person, usually the parents who will manage it for them. Many a gambling addict will end up in the same kind of relationship where someone else basically gives them pocket money once a week. The person who spends all their money and ends up with large credit card debt may be compelled to see a ‘financial’ counsellor who ‘guides’ them on how to mange their money. All these individuals end up in the same kind of position in relationships.

The psychologically interesting part of this person compared to the drug user is the thing they are addicted to does not regress them. Drugs remove the Parent and Adult ego states whereas gambling does not. Thus even while they are engaged in their addiction (at the casino, share trading or on a shopping spree) their Parent and Adult ego states are still quite cathectable whereas the drug user’s is not.

Treatment will tend to have some different features. While engaged in their addiction (at the casino, share trading or on a shopping spree) how do they disconnect their Adult and Parent ego states. They know they are going to end up broke by doing their addictive behaviour so whilst in the actual act of unwise spending they much be able to disconnect at least their Adult ego state to some degree. How they do that is critical to dealing with the addiction.

As with the drug user the regression they are prone to is also necessary to address.

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Drug use and regression

Regression historically has been seen as a defence mechanism. It involves the person reverting to an earlier state or mode of functioning. This is done because in the here and now the person is experiencing anxiety for some reason. In order to deal with that anxiety the person ‘escapes’ by regressing and becoming child like.

For instance if the person is involved in some kind of conflict, the person is being approached sexually, or the person is required to look after a child or become responsible for some reason. If these situations result in the person feeling anxious they can deal with their anxiety by ‘running away’ and becoming child like. Once done they don’t have to deal with the here and now situation and the anxiety is avoided.

Usually the stage to which the person regresses is determined by a fixation point. As we grow through our developmental stages we usually have trouble at some of them and thus don’t completely resolve them. These are then seen as fixation points so when the person regresses they will regress to the stage at which they are fixated. That maybe 3 years old for some or 8 years old for another.

Every person is capable of regression, but some are more liable than others. There are many ways to regress. Those with significant fixations can regress spontaneously as in the situations described above. The more pressure and stress applied to a person the more likely they are to regress.

As I have written before

The mechanism of regression is supported by research in neuro-psychology as cited by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management (Adult ego state). Instead people tend to access the more primitive part of the brain in the amygdala (Child ego state).

In psychotherapy sometimes regressive techniques such as two chair are used. Indeed the therapeutic relationship in itself will pressure the client to regress and become more child like in the relationship with the therapist.

However one of the more efficient ways to regress is to consume alcohol and drugs. When done this situation evolves.


Firstly the alcohol will diminish the Parent ego state and the person becomes disinhibited. The Parent ego state makes us behave in socially appropriate ways and thus people can become aggressive when drinking because their prohibitions against physically hitting out are diminished.

This is also the reason why some men like their female ‘dates’ to drink alcohol because they know it will lower the woman’s own internal prohibitions about sexual behaviour.



With more consumption of the drug the Adult ego state is then decathected such that one is only left with the Child ego state and the regression is complete. Thus we have the link between drug use and the mechanism of regression. It seems reasonable to conclude that some drug users may have this motivation in their substance use. They are unconsciously motivated to regress.

If this is the case then there are treatment implications. As mentioned before the person will regress to that stage of development where they are fixated. Their normal psychological development for some reason got stuck at a particular stage and thus the Free Child seeks to return to that stage in the hope that somehow it will be resolved this time around.

The chronic alcohol user is often fixated at the oral stage of development which would require some kind of therapeutic resolution of the fixation there. That is to work through the developmental issues relevant to that stage with the therapist. If the person is using drugs for the need to regress then one would not expect the usual behavioural techniques to be all that effective.



The thing about regression is that it is a running away or an escape from the here and now. Like the scared young child who simply closes her eyes and puts her hands over their ears as a way to deal with stress. In this sense regression as a defence mechanism is a very child like solution. Compared with intellectualisation which is sort of a more grown up reaction or other defence mechanisms where the Adult and Parent ego states do not disappear.

Of course a person who is regressed will attract others who will take on the parental role in a relationship with them. Thus we end up with people who are called enablers, co dependants and so forth. Of course they will say they want to husband to stop drinking, being child like and irresponsible but the other side of the wife does not.

With regression and drug counselling

Adult and Parent ego state development
Working through the fixation in the therapeutic relationship with the therapist
Altering relationships which encourage the regressive behaviour

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Three reaction to stress & suicide

Solutions to problems or high stress. It is generally acknowledged that the more a person is placed under stress the more they will revert to their childhood solutions to problems and the more they will regress, as it is known. This means they move from the Parent and Adult ego state into the Child ego state as is shown in the diagram 1 below.

Diagram 1

This illustration shows that as one is placed under more and more stress, the more they will revert to their early ways of thinking, feeling and behaving. The more childlike they will become in their thinking and behavior and the more obvious their early decisions become in how they behave. They move from their grownup Adult and Parent ego states into the Child ego state part of self. This is supported by research in neuro-psychology as is shown by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management. Instead people will tend to access the more primitive part of the brain in the amygdala.

When this happens the early decisions about how they should think and feel become more pronounced. These early decisions influence the current decision making much more than if the Parent and Adult ego states were fully operational. As a result one finds such people making decisions that may seem quite out of character for them Decisions can be made which seem odd and even bizarre based on the facts at the time because it is the early child like thinking that is dominating in the personality.

Generally there are regarded to be three main responses to high stress. In 1915 an American physiologist called Walter Cannon described the fight or flight response. This is a fundamental response to a threat or perceived attack where the person will either fight the attacker or flee from them. Since that time another response has been added and that is the freeze response where the person does not either attack back or flee they just freeze and end up doing nothing. This freeze response is seen as the ‘playing dead’ reaction. In the animal kingdom sometimes an animal will play dead so that its attacker thinks it is dead, becomes bored and then moves away. A good example of this is the mouse who is caught by a cat. It plays dead in the hope that the cat will tire of it all and become distracted onto something else.

Everyone has used all three at some time but we all will have one basic response that we use when there is a very high threat or very high level of stress. It is our last bastion when all other options have been tried. Our most basic response to stress of course will be the one that we decided upon as a young child and which fits most with our basic temperament. Our temperament will effect our decision making to varying degrees and thus will effect wether we choose fight, flight or freeze as our primary solution to problems and stress.

Fight, flight or freeze?

Below are some behavioral examples of how a person may respond to threat in each of the three ways.

Fight - this person may physically hit out (as can be the case in domestic violence), verbally hit out, fight for their rights, put in a complaint or sue somebody. In childhood this is the child who will hit out, shout in their defense, maybe break property or try and hurt the other person in some way. The primary response is to fight up against the adversary either overtly or covertly. When under great stress this person will tend to hit out at others physically or verbally. In childhood the child may voice disapproval at mother and father or seek to angrily get change in some way in the home. If mother and father are fighting the child may actually seek to intervene in some way between them.

Flight - This solution may include things like using alcohol, drugs or prescription medication. All these are a way of getting away from the problem as a means to solving it. The person who quits their job and simply goes elsewhere. Here one chooses to geographically relocate or to move away from the problem thus solving it in their mind. In childhood the youngster may display running away from home behavior or the child may go and hide under their bed as a response to stress in the home. Unlike the fighter this child does not seek to change the conditions in the home or express their disapproval instead they move away from the problem and wait for it to subside. They want to ‘slide under the radar’.

Freeze - In earlier times this person would have been diagnosed as having a nervous breakdown. In essence the person collapses in on self and goes into a state of incapacitation. They simply fall to the ground or crawl into bed and go into the fetal position. These days people go on stress leave from work, they may seek hospitalization, some can have panic attacks and agoraphobia which are both incapacitating conditions that can keep them home bound. In childhood the child just stands there and simply does not know how to respond. In the extreme they can loose bowel or bladder control. Whereas fight is primarily an angry response, freeze is mainly an anxiety response.

Suicide primarily is a flight response. One solves the problem by getting away from it and suicide does indeed do that. Interestingly enough in the histories of suicidal individuals it is not uncommon to hear of them report running away from home behavior which of course is the flight response as well. Most often if a child says they are going to run away from home, when asked where they are going to run to they has no answer. In essence the child is running away to oblivion.

Suicidal individuals are in a state of considerable distress and often confronted with some very difficult problem whether that be a recent event that has occurred or just an increasing state of malaise, melancholy and distress that has evolved over time. Thus they will act in more child like ways as mentioned before. When taking a client's history they reports flight as a main way of dealing with stress then this is another point to note when making a suicide risk assessment.

All people fight suicidal urges to some degree. If they did not then it would not be long before their did indeed die. If however the person has a primary flight response then they will be more willing to give up on the fight and take the flight solution of suicide. If the person has a strong fight response then you know they will be less likely to give up and make a serious suicide attempt. The no suicide contract can be particularly useful for this type of indidivual. They can use it as part of their fight response.

Counselling generally speaking is a fight response. Client's wish to identify the problem, find the cause of the problem and then change it rather than simply moving away from the problem. However this is not always the case. Some people will use counselling to identify the problem and then seek ways of getting away from it. Depending on what the problem is, either approach can be useful.

For instance if the client has a primary fight response and has a problematic relationship with mother they will tend to try and alter that relationship by changing self or by negotiation. Those with the flight response will not try so much to alter the relationship but will tend to take the solution of simply never seeing mother again. Some people come to counselling to get permission to do precisely that. To get approval from the counsellor and make a decision to terminate the relationship with mother. Obviously as a therapist it is conducive to work out which of these responses the client is essentially looking for.

Those with the flight response are much more likely to seek a purely medication approach to their problems of emotional distress. For instance the medication approach to depression is a example of a flight response. If it is found to be successful then that person would have little interest in seeking a counselling approach as well. On the other hand one not uncommonly meets clients who say they don't like taking medication as it does not solve the problem and they will seek to find the cause of the problem and try and remediate that.

Sometimes the fight response can be the problem in the itself. If the person has a toxic relationship with their mother that brings them great angst they can seek to change it. The problem with changing relationships is it usually requires both parties change. If mother refuses to then there is not much you can do about that. The person with the fight response will tend to continue to try to change the relationship (mother).

Sometimes it is very hard to accept

that things can not be changed

Some things you cannot change and the person with the fight response will have trouble identifying those times and will get stuck trying to change the unchangeable. The therapeutic goal in these circumstances is for the person to give up their fight which some can find very hard to do.

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