Travel and commuting and its impact on substance use.

Do you suffer with jet lag, car and bus lag, or train lag, and find yourself self-medicating for the disorienting symptoms of the lag blues of fatigue, malaise, lack of motivation, frustration, anger, anxiety, and agitation?

Margaret Fetting, Ph.D., is a professor at the USC School of Social Work and the author of Perspectives on Substance Use, Disorders, and Addiction.

Editor: Nadeem Noor

Most of us commute to work by car or bus, sometimes for up to three hours a day.  Many of us travel weekly for business by plane or train.  Global opportunities invite more and more of us to travel by international air for business as well as for pleasure, vacation, and relaxation.  We are on the move much of the day, traveling well beyond the familiarities of our homes and local communities.  We cross time zones, neighborhood zones, county and state zones for employment, and sometimes for relaxation.  As a consequence, many of us live with the lag blues.

Let’s look at this word, lag—to lag is to fall behind, not keep pace with ourselves, struggle, and hang back.  In short, lag suggests that we fall out of balance with our natural, physical, and mental equilibrium.  Travel and commute these days require that we abandon our comfort zones.  Instead, we feel we must endure distress and discomfort on a daily basis.  Most of us overlook the disorienting symptoms involved in preparing and recovering from commuting and traveling.  The stresses involved include packing a suitcase for a trip; remembering to bring a gym bag for after-work exercise; making sure children and spouses at home have lunches and dinners, school transportation, playdates, and doctors’ appointments covered; figuring out alternatives when something important is left behind; being stranded in delay on freeways, highways, or runways; anticipating heavy rains, heat, or blizzards; equipment failure; and forever traveling with the question, “Are we there yet?”

We are more and more asking ourselves to live in ways that are not simpatico with our psychobiological wiring.  We are not equipped to handle these stresses and also remain in a balanced state of mind.  We often reach for alcohol, drugs, food, smartphones, and other compulsive processes to soothe the grossly unpredictable, disorienting, and dislocating effects of our lag travel.  All too often, we carry a goodie bag of unhealthy snacks in the car, stop for fast food on the highway, head for the snack bar or the lounge in the airport, mindlessly refresh Facebook and endlessly surf the web, or dangerously carry a flask or a joint on our person—all to quiet the physical and psychological discomfort of these commuting and traveling demands.


Sheila – Car Lag

Sheila, a patient in my private practice, moved to northern California. We continued conducting therapy sessions over the phone.  Sheila has always loved horses.  She has ridden most of her life, and now lives and works as a lawyer in San Francisco.  She has two horses that she stables two hours out of the city—the board is much less costly.  She travels to her horses every weekend and rents a room in a family home near the barn—also less expensive than an apartment or hotel room.

Every Thursday evening, she packs an equestrian suitcase.  Even after all these years, she still forgets things, and also continues to lose things along the way.  Every Friday afternoon, she faces her dreadful rush hour commute, and arrives at the barn usually drained, but feels compelled to ride at least one of her horses.  Later, she arrives in her room, unpacks, and heads out to the local market in search of some healthy fast food.

Over the years, she has developed a real loathing about the commute, and recently pays more attention to her agitated anticipation for her two glasses of wine after her Friday rides, and her more entrenched habit of compulsively eating French fries and snacks instead of a balanced and healthy dinner.  Her lack of impulse mastery begins to disturb her, and more and more she is able to viscerally and emotionally connect the stresses of the packing, unpacking, and the unfamiliarity with her increased desire to self-medicate.

Sheila is a classic example of an individual who suffers from car lag.  The disquieting experience continually throws her out of physical and mental balance, and she discovers that self-medicating with food and wine restores her to some sense of equilibrium.  As she became more and more conscious of lag effects and registered their impacts, she began to feel as if she had room for some questions:  Is this lifestyle working for me?  How is this impacting my physical and mental health?  What am I doing to myself?  Are there alternatives?

These questions scared Sheila.  She loved her horses, her profession, and so many times she told me in therapy that “the eating and drinking are not that bad.”  Ed Khantzian (1999), founder of the self-medication hypothesis, succinctly articulates why Sheila is unable to dismiss impulses and indulgences whose consequences are harmful.  Without an energized sense of her own value, she is unable to anticipate, articulate, and register the real physical and psychological dangers of her lifestyle.  As a therapist, I held and heard her anxieties about feeling unable to imagine another lifestyle.  I felt her desperation to make her choices work, regardless of the self-destruction that these incurred, and I felt her terror to acknowledge the destructive costs.  I felt her tenacity to hold on to her commute at all costs.  In hearing so deeply, I transferred back to her my libidinal energy of non-judgmental interest and concern.  She began to internalize this energy and, indeed, began feeling her own self value with an increased ability to acknowledge the destructive consequences of her lifestyle choices.  With an increased sense of self worth, Sheila became invested in making more moderate choices about her wine and food.  She recognized the symptoms of her car lag and began making alternative decisions—decisions she felt unable to make months before.  These included leaving later on Friday evening to avoid the edgy frustrations of a rush hour commute; reconsidering her decision to ride her horses on Friday night or Saturday; buying and stocking up on healthy foods in her room; embracing her car lag symptoms, including frustration and fatigue, a dizzying disorientation, anger, and anxiety.  Sheila began to connect her dismissal of the existence of these emotional states with the need to self-medicate with wine and junk food.  Sheila continued be more conscious about her decisions.

Elizabeth and David – Train Lag

Elizabeth and David bought their dream home in the suburb about 90 miles south of Los Angeles.  Their two children were enrolled in a highly ranked school district, and the community was family centered.  Elizabeth was a homemaker and also a part-time seamstress.  David was a benefits administrator at the University of Southern California.  Their town was on a train station stop, allowing David to commute to downtown Los Angeles Union Station, and then pick up a USC shuttle bus to campus.

David woke up at 4:30 every morning, went to the area gym, worked out, and was on the 6:15am train arriving at USC by 8:00am.  He picked up the last train of the day arriving home at 7:00pm.  The honeymoon of the dream home, the dream job, and “easy” commute lasted for about a year.  At that time, he began to feel that he was living a life of obligation with less and less time for himself. Elizabeth greeted him at the front door every evening with two children in tow and handed them over to David.  At first, he was willing to help, but in time he felt the pressure to “be there for my wife and kids, regardless of how exhausted I was.”  He felt trapped and obligated.  He continued to be the good dad, despite increasing anger and resentment.

Lance Dodes (2002) of Harvard reminds us that addiction or compulsive self-medicating activities are always psychological in nature.  He continues that the behavior is always a substitute action, because a healthier option does not seem possible or permissible.  Over time, and then repeatedly, David filled an 8-oz. flask with vodka and included it in his lunchbox.  He soon looked forward to getting off the USC shuttle bus after work and settling into his train seat.  He opened his flask and took some swigs.  He felt immediate relief and sighed, “See, I can handle all this and will also be able to parent my children without my edge of resentment.”  This went on for a couple of years, and included an increasing number of angry quarrels with Elizabeth.

David called me for therapy and was concerned about his uncanny dependency on this train ritual.  It really surprised him that he allowed this habit to develop, as he had neither a personal nor family history with alcohol troubles.  He was both bewildered and remorseful.  David gradually began more freely acknowledging the insidious costs of his lifestyle, the ongoing discomfort of the pressure he lived with, his body’s constant sense of depletion, the disorienting aspects of train travel over many counties and communities, the sitting with strangers, the lonely agitation of a train ride that rendered him unable to read or work, the anticipatory dread of a 16-hour commute day, and the helpless feeling of being unable to make another choice.

We talked in greater depth about the substitute nature of his liquid train ride and the regret and disappointment that followed.  Gradually, we began broadening perspectives and imagining alternatives.  We explored all this in a non-judgmental tone, which created a space for him to decide that he could and wanted to do something different.  We identified problematic use at a problematic time, and considered alternatives to abstinence as he wanted alcohol in his life and feared his wife would demand that alcohol be taken away from him.

We articulated the costs of his train lag, including compulsively exercising at 4:30 in the morning, which he began to reconsider.  “I never want my kids to see me gulping alcohol from a flask.”  He actively explored the “safety and protection” of bus pooling, as well as telecommuting, and afternoon daycare.  He and Elizabeth were open to the concept of train lag impacts.  They grasped the destructive realities of commuting, and increasingly felt less trapped.  “Commuting is a contemporary necessity and reality—making destructive choices to survive it is not.”

Lee – Jet Lag

Lee is a 55-year-old international executive living in Los Angeles, London, and Munich.  His family resides in London, and he commutes back and forth, usually involving 15 trips a year.  The early excitement and success of his career overrode feeling any symptoms of jet lag, until recently.  He found himself dreading packing and unpacking, dreading airports, cancellations, and travel delays.  He is increasingly short-tempered and edgy with his family members, lethargic, gaining weight, and generally feeling out of it.

We began to talk in therapy, and I soon experienced a man without a country or a home that felt lost and lonely, but couldn’t allow himself to feel these emotions.  Instead, he approaches therapy about his weight gain and increased use of alcohol.  “I feel really safe and comfortable, like everything is okay, when I’m sitting in an airport lounge during a layover drinking gin and tonics.  After a few of them, I gobble down a few sandwiches, and then set an alarm and fall asleep.  When I’m awakened for my flight, I gulp another gin and tonic and race to the gate.  The only good thing now is that I drink a lot of water between gin and tonics on the plane.”  Lee feels his body and soul breaking down and knows he can’t keep doing this forever.  He is worried.

Bruce Alexander’s work on the dislocation theory of addiction (2011) is unique because it takes into account both the exciting and destabilizing impacts of our globalized world, including jet lag.  He understands people like Lee who feel overwhelmed, frustrated, rushed, and out of balance, and live with a disorienting sense of not being anchored in the world.  Alexander suggests that we seek pseudo-relief and equilibrium with the excessive use of substances or compulsive processes to soothe a feeling of “global weightlessness” (Fetting, 2015).

Lee and I began more deeply exploring globalization, its dislocations, and the disturbing experiences of his jetlag.  He felt embraced and understood by Alexander’s theory.  “He really gets what this lonely and isolating experience is like, and what we global travelers do to survive.”  Lee felt less shameful about his compulsive habits and felt free enough to consider alternatives.  His first choice was to have only one glass of wine in an airport lounge and one glass of wine on an international flight.  Lee gradually increased his desire to make healthier choices, and eventually made the decision to travel less.

Closing Comments

Hopefully this blog will encourage readers to consider the pervasive nature of lag blues and encourage a more conscious reflection and articulation of these stresses and their relationship to increased use of substances and compulsive processes for self-medicating purposes.

Courtesy: PsychologyToday

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