Cause or effect, self medicating?
I was wondering the same. What is the cause and what is the effect?
Since they included alcohol: self medicating. If they had stuck to illegal drugs: causality.
Great point. It caused something of a crisis in mental institutions when cigarette smoking was banned, as many patients self medicated with it. Having no replacement for their nicotine, it was much harder for many to “maintain” their stability.
Often this resulted in serious mental and physical harm.
However, the mental health medical community is adamant that smoking is so harmful that it is better that patients have episodes, or are even harmed, lest at some future time they are not likely to survive, they could be harmed.