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I will say I find most of the people who are self medicating have underlying problems.
Drug abuse to extremes, meth, pot, coke, whatever have a lot of imbalances. They are trying to get to feeling “good” or “better” or whatever that means. The drug impacts them for a short time and they continue.
Alcohol is another drug, where you probably have met someone who has drastic changes when they are drinking, possibly they are not able to metabolize it properly and act erratic, or it magnifies the issues they are having with the lack of inhibitions. While YOU as an individual may not show some of these signs, a large group of people do have issues with drugs and alcohol. Those people then do extreme things. Study 1000 people, you will find outliers. People who are hardly impacted by any but the largest amounts, and others who even a small amount go crazy. Most are in the middle of the bell curve, but we are seeing the issues with those who are so messed up that they will never be able to have an even close to normal relationship with the drug/drink or the world.

Is it the drug as the problem, or they symptom of the problem with their minds and self control? I’d say a lot of both.

they are not able to metabolize

Everyone is different. My doc just did a dna pharmacogenic (or something like that) test on me. It goes into your DNA and tells you which drugs work and which ones won’t according to your DNA. Was very enlightening. Found out all the anti depressant drugs and psychotropic drugs just won’t work on me. So if I’m nuts I guess I’ll just have to stay that way. lol But something as simple as Plavix won’t work on me either. So without the test a doctor would prescribe Plavix for me not knowing it wasn’t working. He did the same test on Hubby and they all work on him normally. Not sure why more docs aren’t running this test since it helps them better prescribe medications.