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The Self Medication Theory of Addiction

People Self Medicate Underlying Problems With Drugs and Addictive Behaviors

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Updated April 09, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What Is the Self-Medication Theory?

The theory of self medication to explain addictive behavior is based on the idea that people use substances, such as alcohol and drugs, or the effects of other addictive behaviors, such as eating or gambling, to compensate for underlying problems that have not been adequately treated. The self medication theory usually refers to substance-based addictions, but it can also be applied to non-substance addictions.

Background

The self medication hypothesis began appearing in medical journals in the 1970s, as clinicians noticed that heroin addicts were using the drug to cope with problems such as stress and loneliness. This lead to the idea that drug use develops as a way of coping with stress in the absence of adequate solutions and meaningful social relationships.

The theory gained momentum as it was recognized that many medications prescribed for legitimate ailments are similar to recreational drugs. It was further popularized by the increasing recognition in the medical community that marijuana, typically thought of as a purely recreational drug, has many medicinal properties. The theory goes that, for some conditions, such as chronic pain, prescribed medications may be insufficient or problematic, and so marijuana users who suffer from chronic pain are simply self-medicating. This has lead to medical marijuana now being available on prescription in some places for the treatment of certain conditions.

Responses to the Self-Medication Theory

The self medication theory is increasingly popular among people with addictions and professionals who treat them. While some who take a hard line on addictions believe the self-medication theory is an excuse for irresponsible behavior, many in the medical profession find it useful to transition people from substances and behaviors that they are addicted to and are causing them problems to more controllable prescription medications that address the underlying problem directly. Depression, for example, can often be successfully treated with antidepressant medication, freeing the individual from seeking emotional comfort in their addiction.

The theory is compassionate to people with addictions, particularly illicit drug users. It presents them not as weak-willed, but as creative problem-solvers, who are attempting to fill the gap left by limited medical options.

The self medication theory is also helpful to the therapeutic process, as it provides a clear path out of addiction that unites professionals with people struggling with addictions. They have a shared goal of correctly treating the underlying problem, and can work together to achieve this.

However, some argue that the theory may absolve illicit drug users of some of the responsibility for their problems. Another stance taken against the self-medication theory is that by arguing that people with addictions are self-medicating, the theory legitimizes drug use, and medication generally, as a way of solving emotional problems. Many people who have been through the process of becoming abstinent feel that any drug use, including medications, allows people to avoid dealing with psychological issues and reinforces denial.

In tandem with this, the self medication theory reinforces the disease model of addiction. It runs the risk of simplifying the complex issue of addiction, which involves many psychological and social factors, to pure physiology.

The Future of the Self-Medication Theory

More and more people are going public with their addictions. Addiction and its treatment are no longer swept under the carpet, and these issues have even become the subject of reality shows, such as "Intervention." Many celebrities, and even politicians, have admitted to past drug use.

With greater social change and openness about drug use and addictions, society is becoming more compassionate towards those with addictions. The drug legalization movement and the medical marijuana movement, both of which have become increasingly mainstream, support the self-medication theory. The theory will likely play an important role in current and future concepts of addiction.

Sources:

Grinspoon M.D., L. and Bakalar, J. Marihuana: The Forbidden Medicine. New Haven, CT: Yale University Press. 1997.

Kasten R.N., Ph.D., B.P. "Self-medication with alcohol and drugs by persons with severe mental illness." Journal of the American Psychiatric Nurses Association 5:80-87. 1999.

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Khantzian M.D., E.J., Mack M.D., J.E. and Schatzberg, A.F. "Heroin use as an attempt to cope: clinical observations." Am J Psychiatry 131:160-164. 1974.

Khantzian, E.J. "The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence." Am J Psychiatry 142:1259-1264. 1985.

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