For millions of individuals living with multiple sclerosis (MS), navigating daily life involves a constant balancing act of managing unpredictable flare-ups of fatigue, pain, stress, and depressive symptoms. To cope with these debilitating challenges, many people turn to commonly available psychoactive substances—whether for recreation, socialization, or the direct self-management of their symptoms. However, a new study reveals that this everyday reliance on substances like caffeine, alcohol, nicotine, cannabis, and opioids is a delicate double-edged sword, frequently offering fleeting moments of relief while simultaneously exacerbating other severe MS symptoms.
Published in the Archives of Physical Medicine and Rehabilitation, the research sheds critical light on the complex relationship between psychoactive substance use and the day-to-day lived experience of MS. Led by Anna Kratz, PhD, a professor of Physical Medicine and Rehabilitation at University of Michigan Health and head of the Kratz Lab, the research team set out to look beyond generalized surveys and capture the real-time, fluctuating realities of how these substances affect patients.
Capturing Real-Time Realities Through Ecological Momentary Assessment
Understanding the true impact of psychoactive substances on chronic neurological conditions has historically been challenging. Traditional research often relies on retrospective reporting, where patients try to recall their substance use and symptom severity over weeks or months, a method notoriously prone to memory bias. To overcome this hurdle, Dr. Kratz and her colleagues utilized an ecological momentary assessment (EMA) approach.
This sophisticated real-time methodology required study participants diagnosed with multiple sclerosis to report their symptom severity and recent substance consumption four times a day for a rigorous 14-day period. By checking in with participants multiple times daily, the research team could track the immediate, short-term temporal associations between what individuals put into their bodies and how their bodies responded hours or even minutes later.
During each of these check-ins, participants documented 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 their symptom ratings. By pairing these momentary symptom ratings with precise data on substance use, the researchers began to uncover distinct patterns. The analysis revealed that while certain substances might dull a specific symptom in the short term, they often triggered unintended adverse consequences elsewhere, complicating the overall clinical picture for patients.
A Complex Trade-Off: Short-Term Relief Versus Amplified Symptoms
The findings underscore a phenomenon that many clinicians suspect but have rarely been able to quantify with such fine-grained temporal detail: self-management through psychoactive substances rarely comes without a cost. Just as a healthy individual might reach for an afternoon cup of coffee to shake off midday sluggishness, people living with multiple sclerosis frequently turn to specific substances to target localized discomfort or low energy.
"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.
However, the real-time data demonstrates that the physiological outcomes of these choices are rarely straightforward. While a substance might successfully alleviate a primary complaint, it frequently amplifies another. For instance, relying on stimulants to combat profound MS-related fatigue may inadvertently spike stress or anxiety levels. Conversely, turning to depressants like alcohol to soothe chronic pain can intensify depressive symptoms or exacerbate underlying fatigue as the substance wears off.
These mixed outcomes highlight the sophisticated pharmacological and neurological interactions occurring within a central nervous system already compromised by the demyelination and axonal damage characteristic of multiple sclerosis. Because MS affects nerve signaling throughout the brain and spinal cord, the introduction of exogenous psychoactive substances can trigger unpredictable ripples across various symptom domains.
Bridging the Gap Between Patients and Healthcare Providers
One of the most vital takeaways from the study is the urgent need for open, non-judgmental communication between multiple sclerosis patients and their clinical care teams. Dr. Kratz strongly encourages patients to proactively discuss their habits regarding outside psychoactive substances with their healthcare providers, whether those substances are used habitually, socially, or strictly as an informal strategy for symptom control.
At the same time, Dr. Kratz emphasizes that providers must cultivate an environment of attentive listening. Given the prevalence of substance use among the general population and chronic illness communities alike, patients are bound to continue utilizing these products to navigate their daily struggles.
"Having a better understanding of how these substances impact patients with multiple sclerosis will be beneficial for providers," Dr. Kratz 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."
By acknowledging the real-world reasons why patients turn to substances—such as the desperate need for pain relief or a momentary boost in cognitive clarity—clinicians can move past prohibitive stances and instead engage in constructive, individualized risk-benefit discussions. Insights from studies like this one can serve as a valuable mirror for patients, prompting them to reflect more critically on their daily habits and evaluate how specific substances are genuinely impacting their overall quality of life.
The collaborative research effort behind these findings involved a multidisciplinary team of experts dedicated to advancing rehabilitation science. Additional authors on the study 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 paper, titled "Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis," was published in the Archives of Physical Medicine and Rehabilitation.
