DIFFERENT BEHAVIORS, SIMILAR ISSUES: THE CONNECTIONS BETWEEN SELF-INJURY AND SUBSTANCE USE

By Lori Vann, M.A., LPC-Supervisor

Children as young as 3 years of age are doing it.

Adults who do this are 37 times more likely to attempt suicide in a one-year period.

You have 12-months to intervene before a possible suicide attempt!

What is it? Self-injury.

There are correlations between substance use, suicide, and self-injury; many are stating that self-injury is a form of addiction. In addition, I would state the substance abuse is a form of selfinjury. And all too often, we have seen those who struggle with an addiction taking their own lives once they have hit that final bottom where they feel that they cannot climb out.

My experience has been that unless you address what I refer to as the “core issues”, clients will be highly likely to flip-flop between unhealthy coping skills. Recently, a treatment center counselor informed me that they had seen several cases of those becoming “sober” from substances but had moved into self-injury as their new way to cope. Some may go from injury to substance or injury to eating disorder or participate in both concurrently.

First, let’s define what self-injury is and isn’t because some research articles have used it synonymously with suicide. There are many definitions of what is formally referred to as Non-Suicidal Self-Injury (NSSI), but I prefer to keep things simple by defining it as “the intentional infliction of harm upon one’s body, usually for emotional reasons.” The focus is on the “intent” piece. It is imperative that you do not make assumptions but rather ask about what their intent was behind the injury. Too often, when a client has gone to the emergency room with cuts on their forearms or even their neck, the staff has assumed that they must have attempted suicide.

A couple of quick points: one, NSSI is not a suicide attempt; two, it may look like an attempt, but never make that assumption; three, do not use the term self-mutilation, as it is a dated and inaccurate term; four, it is not an accident; five, do not tell them to “just stop it” or “just don’t do it” because that shows a lack of understanding of the behavior and the client will tune you out; and finally, do not accuse them of doing it for attention. All of these points are further elaborated upon in my first two books.

A little background on my ability to write this article. When it is stated that I am regarded by professional peers and the community as an Authority in the Prevention and Treatment of Self-injury, it is based upon twenty years of research and counseling 500 cases with consults on well-over a hundred more. I have written four books, soon to be five, on the topic with the first being, A Caregiver’s Guide to Self-injury (2014) followed by A Practitioner’s Guide to the Treatment of Self-injury: Tips, Techniques, Activities, and Debates (2015) with a companion workbook (2018) and The Self-injury Prevention Activity Workbook. In 2018, I developed the Self-injury Prevention and Intervention Program (SIPIP) for schools and treatment centers, which is now located in two states.

Having counseled in a variety of locations from the non-profit sector to inpatient psychiatric, an outpatient clinic, school district, and in my own private practice for over ten years, I have seen the increase in the number of cases and the decrease in the age of onset. This is alarming to me and it is my passion to spread education and resources about NSSI and suicide on a National and International level.

When I first started to present on the topic around 2000, most people had not heard about the behavior and even fewer assessed for it as part of their Intake procedures. Having given approximately 100 talks on the matter in two countries, it has been a positive shift in the professional community to see the number of professionals assess for the behavior and respond appropriately to someone who answers in the affirmative, but there is still much work to be done.

Recently, I had the pleasure of interviewing Dr. Phil McGraw regarding the topic of self injury and his opinion as to why he believed that there had been an increase in the number of cases; his response to my question was humbling and in line with what I had seen with my clients.* First, he stated that he thought that the increase was due to anxiety. Without a doubt, the number of cases of anxiety, in all its many forms, has increased during the last ten plus years. Secondly, he believed that the increase in anxiety was related to social media. As he said, it is “like getting your paper graded each day” as to how “liked” you are. People feel the real orperceived pressure to look or act a certain way for their “audience”.

A related element with self-injury, substance use, and anxiety that I discuss in a co authored book, CAUSE OF DEATH: Political Correctness, is resiliency. When people do not develop resiliency for life’s struggles, they seek out whatever methods they can find that will bring them some type of peace…even if they know it is not the healthiest of options. Tough day at work…stop by the bar and drink until you feel relaxed. Things getting intense in the office…. go grab a cigarette. Breakup with someone…take a pill and sleep it off. Didn’t get your project turned in on time and you receive a bad review…punish yourself with an injury.

Resiliency is like a muscle that has to be stretched, pushed beyond its comfort zone, tested, and toned in order to build it up. Anxiety tends to lend itself to avoidance and you can’t build something up if you keep avoiding it. Those who self-injure tend to struggle with setting boundaries with people and may avoid individuals if they feel like they cannot say “no” to them. Similarly, those who feel anxious in a social setting may drink more to try to “calm their social nerves” or give them some type of distraction instead of being fully present.

In the end, there are many more similarities than differences when it comes to unhealthy coping skills. The key items to remember are to ask questions and not make assumptions, become educated as to the differences between NSSI and suicide, understand how similar NSSI and substance abuse are, do not focus solely on the behavior, and that unless you get to  the core, underlying issues that started them on their path, you risk them moving on to another detrimental behavior.

*Interview is available on YouTube and www.LoriVann.com
www.LoriVannCounseling.com
Twitter and Instagram @LoriVannLPCS
Lori@LoriVann.com