Young adults are swapping alcohol for pills like pregabalin to manage social anxiety. Our Treatment Manager on why the pattern is older than the drugs.
There are a few things happening at the same time. Anxiety among young adults is high. In UCL’s Millennium Cohort Study, 28% of people reported high levels of anxiety at age 23. Getting professional help can also take time, while prescription drugs can now be bought quickly and easily through social media.
It’s not difficult to understand why some young people might see taking a pill as an alternative to drinking. There may be no hangover, no calories and none of the obvious signs of having drunk too much. If the aim is simply to feel less anxious and more confident around other people, taking a tablet can start to seem like the better option.
Alternatives
That’s what stood out to me in the recent coverage. These weren’t necessarily young people taking drugs because they wanted to get heavily intoxicated. Some were using them because they felt anxious in social situations and wanted something that made talking to people, going out or being around others feel easier.
Anxiety
There’s nothing unusual about wanting to feel more comfortable and confident socially. The concern is when you start to feel as though you need a substance before you can do those things.
There are two things that concern me about this. The first is that propranolol and pregabalin are very different medicines, with different risks.
Propranolol is a beta-blocker that can reduce some of the physical symptoms of anxiety, such as shaking or a racing heart. Pregabalin is a controlled drug in the UK and carries recognised risks of tolerance, dependence, addiction and withdrawal.
That doesn't mean that someone who takes pregabalin has an addiction. The concern is when you start relying on it to cope with social situations and find it increasingly difficult to go out, meet people or manage anxiety without taking it. That's the kind of change in someone's relationship with a drug that deserves attention.
The other concern is how these drugs are being obtained. If you're buying pills through social media, you can't be certain that they contain what you've been told they contain, or that the dose is what the seller claims.
There's also no doctor or pharmacist checking whether the drug is safe for you, whether it could interact with anything else you're taking, or whether your use is starting to cause problems. That's very different from taking medication that's been prescribed for you and monitored by a healthcare professional.
both my own and other people's, have taught me that the substance is rarely the whole story. Often, the more important question is what feeling the substance is managing.
before it stopped managing much of anything and started taking more than it gave. Someone else might use cocaine to feel confident, benzodiazepines to quiet their head, cannabis to switch off or pregabalin to make being around other people feel easier.
and so are their effects, but sometimes the bargain underneath is remarkably similar: I don't know how to feel okay in this situation without this.
That's the part worth paying attention to. The coping pattern doesn't care whether it arrives in a glass or a blister pack. When a substance becomes your only reliable way of dealing with a feeling, the feeling doesn't necessarily get smaller. Instead, the number of situations you feel able to face without the substance can start to shrink.
The anxiety these young people are describing is real, and it deserves a better response than shame. Sometimes the answer may be talking therapy. Sometimes it’s support from a GP or mental health service. Sometimes it’s learning, slowly, that an uncomfortable feeling can be tolerated without immediately having to change it.
Where drug use has become difficult to control or is beginning to organise somebody’s life, specialist addiction treatment may also be part of the answer. Our drug rehab guide explains what treatment involves, when residential rehab may be appropriate and what other options are available.
The drugs will keep changing. They always have. But the work underneath them remains remarkably familiar.
It’s about understanding what somebody is trying to cope with, rather than shaming the way they’ve learnt to cope with it, and then helping them find an answer that doesn’t leave them increasingly dependent on a substance just to feel able to live their ordinary life.
