A new study has shed light on a common yet complex aspect of daily life for many individuals living with multiple sclerosis: the use of psychoactive substances for recreation, socialization, or the self-management of chronic symptoms. Conducted by a team of researchers led by Dr. Anna Kratz, a professor of Physical Medicine and Rehabilitation at University of Michigan Health and head of the Kratz Lab, the research reveals that commonly consumed substances often deliver a complicated mix of short-term relief alongside unexpected adverse effects, such as heightened fatigue or stress.
The findings, published recently in the Archive of Physical Medicine and Rehabilitation, offer a nuanced look into how everyday substances—including alcohol, caffeine, nicotine, cannabis, and opioids—interact dynamically with the fluctuating physical and emotional symptoms experienced by people with multiple sclerosis (MS). Rather than providing straightforward therapeutic benefits or purely negative consequences, the study highlights a delicate balancing act that many patients navigate on a daily basis.
Real-Time Tracking of Daily Habits and Symptoms
For many individuals navigating the unpredictable landscape of multiple sclerosis, utilizing psychoactive substances is a routine part of managing the heavy physical and emotional toll of the condition. However, capturing the true nature of these interactions has historically been challenging through traditional retrospective surveys, which rely heavily on memory over weeks or months.
To overcome this limitation, Dr. Kratz and her research team employed an ecological momentary assessment approach. This methodology allowed the researchers to capture real-time data directly from the daily lives of study participants. Over a period of 14 days, individuals with multiple sclerosis were asked to report their symptom severity and substance use four times a day using digital devices.
Throughout the two-week monitoring period, participants logged their current levels of fatigue, pain, stress, and depressive symptoms. They also reported whether they had consumed alcohol, caffeine, nicotine, cannabis, or opioids prior to making their symptom ratings. By combining these momentary symptom ratings with precise timelines of substance use, the research team was able to detect subtle patterns and temporal associations that might otherwise have gone unnoticed in broader, less frequent surveys.
A Complex Mix of Relief and Adverse Effects
When the research team analyzed the gathered data, clear patterns emerged regarding the dual nature of psychoactive substance use. For several of the commonly consumed substances tracked in the study, participants reported a mixture of positive short-term outcomes alongside worsening secondary symptoms.
"Just as many people look to a cup of coffee in the afternoon for a pick-me-up, people with multiple sclerosis may seek caffeine to help with fatigue or alcohol to manage pain," Dr. Kratz explained, illustrating the common motivations behind self-management strategies. While these substances may offer a fleeting sense of relief or a momentary boost in energy, the study emphasizes that this relief frequently comes at a cost, exacerbating other deeply challenging aspects of the disease, such as heightened stress or increased fatigue.
The study’s findings underscore the reality that self-managing chronic symptoms with psychoactive substances is rarely a straightforward clinical solution. Instead, the immediate benefits perceived by patients are frequently counterbalanced by unintended adverse effects that can complicate their overall well-being and daily functioning.
Bridging the Communication Gap Between Patients and Providers
Given the prevalence of substance use among individuals with multiple sclerosis—whether for recreation, socialization, or intentional symptom management—Dr. Kratz advocates for a proactive and open dialogue between patients and their healthcare providers. She encourages patients to reflect honestly on the substances they bring into their bodies and to discuss these habits openly with their medical teams.
"Insights from studies like this could prompt a person with multiple sclerosis to reflect on what they are putting into their bodies and how it is impacting their symptoms," Dr. Kratz noted.
At the same time, Dr. Kratz emphasizes that healthcare providers must cultivate an environment of attentive listening. Understanding the functional role that psychoactive substances play in a patient’s daily routine is crucial for comprehensive care. Because the use of these substances by patients is widespread and persistent, clinicians need a clear understanding of the specific pros and cons associated with each product.
"Having a better understanding of how these substances impact patients with multiple sclerosis will be beneficial for providers," she said. "Patients using psychoactive substances is not going to go away. Being able to understand the role these substances play and the pros and cons of each will allow providers to better advise their patients when it comes to use of these products."
Collaborative Research and Academic Contributions
The study represents a collaborative effort among researchers from several prominent academic and medical institutions. Additional authors contributing to the published work include Jeeyeon Kim from the Department of Physical Medicine and Rehabilitation at the University of Michigan in Ann Arbor, Michigan; Dawn M. Ehde from the Department of Rehabilitation at the University of Washington in Seattle; Kevin N. Alschuler from the Department of Rehabilitation Medicine and the Department of Neurology at the University of Washington; and Nora E. Fritz from the Department of Health Care Sciences and the Department of Neurology at Wayne State University in Detroit, Michigan.
The research paper, titled "Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis," is available in the Archive of Physical Medicine and Rehabilitation under the DOI 10.1016/j.apmr.2026.01.014.
