Department of Sociology and Criminology Valparaiso University April 5, 2013, Our Self-Medicating Culture, St. Louis University Law School Early Development of the Self-Medication Hypothesis and Major Psychological Factors Attributed to Self-Medication Peter J. Venturelli Department of Sociology and Criminology Valparaiso University Arts and Sciences 1400 Chapel Drive, Room 335 Valparaiso, IN 46383

Working Definition of Self-Medication Self-Medication is a method of self care an individual undertakes to use non prescribed drugs to treat untreated and often undiagnosed medical ailments involving an individuals’ psychological condition. The drugs that are self-prescribed can include recreational drugs, psychoactive drugs, alcohol, and/or herbal products in order to alleviate or diminish mental distress, stress and anxiety, mental illnesses, and/or psychological trauma.

Early Development of the Self-Medicating Hypothesis: Edward J. Khantzian and David F. Duncan were the two originators of the self-medication hypothesis (Achalu 2002). Prior to Khantzian and Duncan, Fenichel (1945) and Rado (1957) indicated the existence of an underlying depression as the motive for drug abuse. Further, Glover (1956) suggested that drugs were used to to cope with psychogenic aggression and rage.

Rosenfeld (1965) described drug addiction as a defense against psychotic suffering. However, self-medication hypothesis originated in 1974 in a publication by Khantzian, Mack and Schatzberg

Major Versions of the Self-Medication Hypothesis Initially, Edward J. Khantzian and colleagues developed this self-medication model from clinical experiences in evaluating and treating heroin addicts. They noted that these heroin addicts had difficulties with aggression and rage coupled with depression that long preceded their patients’ use of illegal drugs.

Specifically use of heroin resulted from inadequate ego mechanisms for controlling and directing aggression. Their use of heroin served as a coping mechanism. In other publications Khantzian found that regarding cocaine addiction use of cocaine was very appealing because it relieved the distress associated with depression, hypomania, or hyperactivity. Self-medication hypothesis included alcoholism since excessive alcohol consumption by alcoholics permits the experience of affection, aggression, and closeness in individuals who are otherwise cut-off from their feelings and relationships. Finally, this hypothesis developed into a theory for all drug addictions.

Full Development of Self-Medication Hypothesis Today this hypothesis holds that addiction occurs in a context of self-regulation vulnerabilities. Primarily, difficulties in regulating affection, self- esteem, relationships, and self-care. Prior to addiction, self-medicating patients suffered severely from their feelings either being overwhelmed with painful emotions or seeming not to feel any emotions at all. Drugs of abuse help individuals to relieve painful emotions or to experience emotions that are confusing or threatening.

Character Traits Typical of all Drug Addicts - Khantzian Unauthorized drug-taking behavior results from problems in affect management, self-esteem, object relations, judgment, and self-care. Self-medicating can interfere with emotional maturation (especially when addiction begins during adolescence).

David F. Duncan’s Model Duncan’s model (1974a and 1974b) is a behavioristic model for addressing the self-medication hypothesis and it was a response to Khantzian’s psychoanalytic approach to self- medication Duncan begins by asserting that most people who take illegal drugs (majority of drug users), exercise control and restraint over their drug use and do not suffer addiction. Duncan’s model is concerned with why and how a minority (10-20%) of those who take drugs non-medically do lose control over their use and expose themselves to serious social, interpersonal, and medical risks.

Duncan asserted that drug use is maintained by positive reinforcement (principally from the pleasurable effects of the drug) while drug dependence is not. ________________________ Note: The term drug dependence is a term that formally replaced the term addiction in 1964 by the World Health Organization because dependence takes into account both psychological and physical drug dependence while addiction mainly referred to physical drug dependence, (such as withdrawal from heroin).

Duncan further states that drug dependence is just another name for avoidance or escape behavior when the operant behavior being reinforced is drug-taking. According to Duncan, the characteristics of dependence are all typical of operant behaviors maintained by negative reinforcement. Drug addicts have found that a drug providing temporary escape from an ongoing state of emotional distress may include a mental disorder, ongoing distress, and/or an aversive environment.

Concluding Findings on Self-Medication of Mood Disorders with Alcohol and Drugs in a National Epidemiologic Survey A study by Bolton, Robinson, and Sareen (2009) at the University of Manitoba in Winnipeg, Manitoba, Canada with 43,093 age 18 years and older sample population study found the following: Approximately one-quarter of individuals with mood disorder (24.1%) used alcohol to relieve symptoms. The highest prevalence of self-medication was seen in bipolar I disorder (41%). Men were more than twice as likely as women to engage in self medication. After controlling for the effects of substance use disorder, self- medication was associated with higher odds of comorbid anxiety and personality disorders when compared to individuals who did not self-medicate.

In Conclusion: The use of alcohol and drugs to relieve affective symptoms is common among individuals with mood disorders in the general population, yet it is associated with substantial psychiatric comorbidity. The theory of self medication in explaining 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.

Final Side Note: Self medicating theory is compassionate of people with addictions, particularly illicit drug users. This theory presents them not as weak- willed, but as creative problem-solvers, attempting to achieve normalcy despite limited medical options.

References: Achalu, Ed. “The self-medication hypothesis: a review of the two major theories and the research evidence.” SMH: Recent Developments on the Self-Medication Hypothesis, 1(10), id1, 2002. Available http://self-med-hypothesis.tripod.com/id1.html Bolton, J.M., J. Robinson, and J. Sareen. “Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. J Affect Disorders, (115): 367-75, June 2009. Duncan, D. F. “Reinforcement of drug abuse: Implications for prevention”. Clinical Toxicology Bulletin, 4(2), 69-75, 1974a. Duncan D.F. “Drug abuse as a coping mechanism.” American Journal of Psychiatry, (131):724, 1974b. Glover E. On the Early Development of Mind. New York: International Universities Press, 1956.

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