The Self‐Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

  title={The Self‐Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications},
  author={Edward J Khantzian},
  journal={Harvard Review of Psychiatry},
  • E. Khantzian
  • Published 1 January 1997
  • Psychology, Medicine
  • Harvard Review of Psychiatry
&NA; The self‐medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self‐medication factors occur in a context of self‐regulation vulnerabilities–‐primarily difficulties in regulating affects, self‐esteem, relationships, and self‐care. Persons with substance use disorders suffer in the… 
The Many Faces (and Potential Dangers) of Self-Medication as an Explanatory Concept for Substance Use
The self-medication hypothesis of addictive disorders maintains that individuals use substances to cope with dysphoric affect, and that painful emotional states are etiologically relevant to the
Measuring the unmeasurable, affect life, and the self-medication hypothesis-the case of nicotine dependence in schizophrenia.
  • E. Khantzian
  • Psychology, Medicine
    The American journal on addictions
  • 2016
The self-Medication Hypothesis (SMH) of substance use disorders rests on clinical observations of many substance dependent individuals (practice based evidence) who provide compelling reports and
Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.
This project tested the self-medication hypothesis in a treatment sample of treatment-seeking individuals with substance dependence, using more heterogeneous, personality-driven measures that are theory-congruent and partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.
Substance Use to Regulate Affective Experiences in Posttraumatic Stress Disorder: A Review of Laboratory-Based Studies
Posttraumatic stress disorder (PTSD) and elevated levels of substance use (SU) regularly co-occur and are increasingly viewed as functionally related. While PTSD and SU may be comorbid for a variety
Substance use in severe mental illness: self-medication and vulnerability factors
Pathways to heroin dependence: time to re-appraise self-medication.
  • S. Darke
  • Psychology, Medicine
  • 2013
The self-medication hypothesis emphasizes the role of distressing affect as the primary motivator for the compulsive use that leads to substance dependence. The model also postulates that there will
The Need to Numb: Substance Use and Therapeutic Management
People have long used substances for pleasure, self-medication, and experimentation or due to pressure from friends and families, to enhance concentration, advance creativity, decrease social
  • H. Graham
  • Psychology, Medicine
    Behavioural and Cognitive Psychotherapy
  • 1998
It is suggested that for individuals who experience psychosis and also use drugs or alcohol, the ability to identify the relationship between the substance use and the psychotic illness in terms of a case formulation/conceptualization would provide a good starting point for developing strategies and interventions that are most likely to succeed in treatment.


Drug abuse as self-medication for depression: an empirical study.
The authors empirically studied the self-medication hypothesis of drug abuse by examining drug effects and motivation for drug use in 494 hospitalized drug abusers. Most patients reported that they
Blue mood, blackened lungs. Depression and smoking.
The notion of "self-medication" is one of the most intuitively appealing theories about drug abuse, and clinical observations suggest that persons who have difficulty regulating mood may be particularly vulnerable to abuse of cocaine or other stimulant drugs.
Subjective experiences related to alcohol use among schizophrenics.
Interview data from 75 DSM-III-R schizophrenic outpatients regarding their subjective responses to alcohol is reported, finding that alcohol improved social anxiety, tension, dysphoria, apathy, anhedonia, and sleep difficulties and other nonpsychotic experiences were frequently improved.
Vulnerability to psychopathology in nicotine-dependent smokers: an epidemiologic study of young adults.
Investigation of the associations of nicotine dependence with four measures of psychologic vulnerability to nonpsychotic psychiatric disorders found neuroticism and the correlated psychologic vulnerabilities may commonly predispose to nicotine dependence and major depression or anxiety disorders.
Adolescent drug use and psychological health. A longitudinal inquiry.
Adolescents who had engaged in some drug experimentation were the best-adjusted in the sample, and those who used drugs frequently were maladjusted, showing a distinct personality syndrome marked by interpersonal alienation, poor impulse control, and manifest emotional distress.
Alcohol dependence and anxiety disorders: what is the relationship?
The available data, while imperfect, do not prove a close relationship between life-long anxiety disorders and alcohol dependence, and prospective studies of children of alcoholics and individuals from the general population do not indicate a high rate of anxiety disorders preceding alcohol dependence.
Clinical effects of recent cocaine use on patients with acute schizophrenia.
The clinical effects of cocaine abuse and cessation in schizophrenic patients at two times: when patients presented to the psychiatric emergency service and again after 4 weeks of hospitalization are concerned.
A Hierarchical Model of Opiate Addiction: Failures of Self-Regulation as a Central Aspect of Substance Abuse
A multivariate analysis of variance showed opiate addicts to have greater difficulties in self-regulatory functioning than normal subjects, and the implications for the questions of severity of illness, psychotherapy technique, and future research are discussed.
Psychological Assessment of Psychopathology in Opiate Addicts
Difficulty in interpersonal relations and affect modulation are consistent with disturbances in the neurotic range and suggest that opiate addicts have selected a particularly untoward, self-destructive, isolated mode of adaptation for achieving the satisfactions and pleasures most people seek in intimate personal relationships.
Biological mechanisms in posttraumatic stress disorder. Relevance for substance abuse.
  • T. Kosten, J. Krystal
  • Psychology, Biology
    Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism
  • 1988
Both therapeutic approaches and attempts at self-medication for PTSD have supported the hypothesis that this overlap between central catecholamine and endogenous opioid systems and substance abuse may contribute to the incidence of substance abuse in PTSD.