Drug Abuse and Skin Picking

Drug abuse affects every organ in your body — including your body’s largest organ, the skin. Skin picking and hair pulling are two common reactions to the physical and psychological effects of illicit drug use. Heroin and meth use can cause direct damage to the skin in the form of needle marks and abscesses. Many users compulsively pick or scratch their arms or face in response to anxiety, restlessness or crawling sensations. The side effects of opiate withdrawal, such as agitation and goose bumps, often trigger the urge to pick or rub at the skin.

The compulsive urge to pick at the skin may subside after detox and rehab. But for a lot of users, this condition continues even after the drugs have cleared the body. Skin picking must then be treated as a separate disorder that requires behavioral modification training and possibly psychiatric medication.

What Is Dermotillomania?

Skin picking, or dermotillomania, has been classified as a “body-focused repetitive behavior” (BFRB). The individual who suffers from a BFRB is powerless to stop the behavior, even though it causes physical injury and negative attention from others. Other common BFRBs include hair pulling, cheek biting, and nail or cuticle picking. The American Association for Marriage and Family Therapy notes that BFRBs often occur along with other psychiatric disorders, including:

  • Anxiety
  • Depression
  • Personality disorders
  • Substance abuse


A study published in the Journal of Clinical Psychiatry indicates that a significant percentage of people who practice self-injurious skin picking have other mental health conditions. In this study, which involved 34 patients at a dermatology clinic, all subjects met the criteria for at least one psychiatric diagnosis. Mood disorders, such as depression or bipolar disorder, were the most common. Many of the participants reported that they had a family history of depression or substance abuse.

In the mental health community, dermotillomania is also categorized as an impulse control disorder.

Sometimes Impossible to Resist

For the compulsive skin picker, it is impossible to resist the urge to scratch, pull, pick, or rub at sores or imperfections on the skin.

According to the American Journal of Drug Abuse, pathologic skin picking — which affects more than five percent of the general public and an even higher percentage of those with mental illness — has several traits in common with substance abuse disorders:

  • The individual associates the activity with pleasure and psychological relief.
  • The behavior has a disabling effect on the individual’s life, interfering with social, recreational or professional activities.
  • The individual can’t stop the behavior, in spite of its destructive consequences (pain, bleeding, scarring, infection, etc.).
  • The behavior causes guilt, remorse and self-loathing, yet the individual continues to relapse into skin picking whenever she tries to quit.

Skin picking is more common in females than in males, but both sexes experience this disorder. Like skin picking, hair pulling or trichotillomania, can trigger a temporary rush of pleasure and release that can become as addictive as drug abuse itself. As part of the recovery process, these addictions must be treated with therapies such as behavioral modification training, anti-anxiety medication and intensive counseling.

How Drug Abuse Affects the Skin

Illicit drugs like heroin, methamphetamine and cocaine can take a severe toll on the health of your skin. Heroin is a central nervous system depressant that slows heart rate, blood circulation, respiration and metabolism.

Risks of Use

By suppressing these vital functions, heroin also restricts the flow of oxygen and nutrients to the skin. Heroin abuse can make skin dry, itchy, flaky and cold. When injected intravenously, especially with unclean needles, heroin can cause life-threatening abscesses.

“Skin popping,” or the practice of injecting heroin under the top layer of the skin, leaves distinctive round sores along the skin’s surface. These sores can easily become infected, resulting in permanent scars. For users who are anxious, restless or experiencing cravings, the scabs can become the focus of obsessive picking. Picking at the sores increases the risk of cellulitis, or the infection of the soft tissues underlying the dermis.

Skin lesions are common in heavy methamphetamine users. This central nervous system stimulant can cause a condition called delusional parasitosis, or the false believe that the user is infested with organisms that are crawling across her skin. According to the University of California at Davis, this condition — also known as “meth mites” or “cocaine bugs” — can lead to severe self-mutilation if the user is acutely intoxicated.

Skin Picking and Heroin Withdrawal

Withdrawing from heroin, a highly addictive opiate, is an intensely uncomfortable experience. Restlessness, nervousness, severe cravings and goose bumps can trigger the urge to self-mutilate. Users in withdrawal often say that they feel like they’re “crawling out of their skin.” In this state, skin picking may provide a momentary sense of release.

Heroin withdrawal affects the skin in several important ways. Goose bumps, along with chills, shivering and cold sweats, occur as the brain adjusts to the absence of this powerful opioid. These bumps are caused by tiny muscles that tighten at the base of the fine hairs that cover the skin. For the user in withdrawal, compulsively rubbing or tugging at the skin may counteract the sensations of cold and restlessness.

Skin picking and self-mutilation can also help the user cope with opiate cravings. The sensations of pleasure or pain are a temporary distraction from the desire to use heroin. Ritualistic picking can provide an outlet for the intense anxiety, nervous tension and restlessness that characterize withdrawal.

But skin picking provides only a temporary relief from the symptoms of opiate withdrawal. Once physical withdrawal symptoms begin, they can last for several days. The best way to avoid withdrawal symptoms like goose bumps, sweats and muscle pain is to enter a medically supervised detox program. At a detox center, you can receive the physical and moral support you need to minimize the symptoms of withdrawal and avoid a relapse.

Treatment for Skin Picking Disorders

Treatment for body-focused repetitive behaviors must begin with a comprehensive psychiatric assessment. An initial, personalized assessment should cover the following areas:

  • What triggers the behavior?
  • What does the individual get from the behavior?
  • Does the individual have co-occurring mental health problems, like anxiety or depression?
  • Does the individual have an alcohol or drug problem?
  • Does the person have a family history of mental illness?
  • Has the person tried any medications or therapies in the past?

Although the U.S. Food and Drug Administration has not yet approved any medications specifically for the treatment of BFRBs, several drugs have been used successfully to control the impulse to pick or scratch the skin.

The Trichotillomania Learning Center lists these medications as potentially helpful:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and escitalopram (Lexapro), have been approved for the treatment of depression and/or obsessive-compulsive disorder
  • Tricyclic antidepressants, such as amitriptyline (Elavil) and imipramine (Elavil)
  • Opioid antagonists, such as naltrexone (ReVia), are used to reduce the pleasurable effects of alcohol and certain narcotics
  • Neuroleptic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), are used to treat repetitive, compulsive behaviors

Along with medication, behavioral modification therapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help reduce the urge to self-mutilate. These therapies have also proven to be valuable in the treatment of drug addiction.

Alternative Treatments

Alternative treatment modalities like acupuncture, guided meditation, hypnotherapy, and biofeedback can help the recovering addict control anxiety-related behaviors and manage stress more productively.

Hope for Compulsive Behaviors

Skin picking and hair pulling, like drug or alcohol abuse, are acts of compulsive self-destruction. The mental health professionals who staff Foundations Recovery Network are aware of the deep intersection of addiction and impulse control disorders. Our Dual Diagnosis treatment facilities are uniquely equipped to help you overcome the challenges of psychiatric illness and substance abuse.

We encourage you to call our toll-free number, 844-496-9429, and our admissions coordinators can tell you more about your treatment options and start the process of healing today.

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