Self-Medication Hypothesis of Addiction

By the 1990’s the term was used to describe a general model of addiction that posits that people use substances as a self-regulation strategy, due to difficulties in four different areas: self-esteem, emotions, interpersonal relationships, and self-care. Lesia Ruglass, PhD, describing the self-medication hypothesis of addiction

The term “self-medication hypothesis” was coined decades ago by psychiatrist Edward J. Khantzian. He and and Mark J. Albanese, who has a specialization in addiction psychiatry, wrote the 2008 Understanding Addiction as Self Medication: Finding Hope Behind the Pain. 

Unfortunately, using drugs and alcohol to “treat” symptoms doesn’t mean one’s mental issues won’t eventually worsen. “In the short-term, substances may indeed…reduce painful emotional states. However, as the brain changes over time in response to heavy substance use, a rebound process may occur which can lead to an exacerbation or worsening of psychological symptoms” (website of Lesia Ruglass).

Examples of how self-medication operates (Marc Lewis, Psychology Today):

At the very least, drugs, booze, gambling and so forth take you out of yourself. They focus your attention elsewhere. They may rev up your excitement and anticipation of reward (in the case of speed, coke, or gambling) or they may quell anxiety directly by lowering amygdala activation (in the case of downers, opiates, booze, and maybe food). The mechanisms by which this happens are various and complex. But addicts and ex-addicts (like me) know what it feels like. If we find something that relieves the gnawing sense of wrongness, we take it, we do it, and then we do it again.

Addiction Campuses lists “Five Signs You May Be Self-Medicating“:

  1. When you become stressed, depressed, angry, anxious or uncomfortable, you drink or get high.
  2. Your moods and mental well-being worsen from drinking or getting high.
  3. You worry when you can’t drink or get high.
  4. Your problems just keep growing.
  5. Your loved ones, family and friends are concerned by your drinking or using.

Depending on various factors, such as the severity of mental/emotional symptoms that have been “medicated” with unprescribed substances and the severity of symptoms when deciding to seek help, a new client may need help with both a mental condition and substance abuse or dependence. This is referred to as dual diagnosis or co-occurring disorders.

Treatment has to be aimed at both conditions. NAMI (National Alliance on Mental Illness): “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance abuse. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated—current thinking requires both issues be addressed.”

Each individual is assessed and a plan is determined by the specialized provider(s). Some common steps include detox, inpatient rehab, supportive housing, therapy, medications for withdrawal and/or mental symptoms, and support groups.

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