The Self-Medication Theory of Drug Addiction

Since the beginning of time, human beings have been looking for medicinal plants or wanting to consume substances with curative or recreative purposes. This might be the reason why so many people consume psychoactive substances nowadays.

This habit is part of the beliefs and ideas of each era regarding health and diseases. For example, at the beginning of the twentieth century, people saw addicts as lazy and despicable beings who didn’t have enough willpower to control their impulses.

Khantzian, a psychoanalyst who treated addicts at Harvard University, began to think about the reason why addicts consumed said substances. This author developed the self-medication theory, which says that the main cause of substance consumption is the person’s inability to tolerate negative states.

Currently, substance abuse is a great public health problem. It has a great impact on society and major social, judicial, and political implications. That’s why people thoroughly research the causes and the consequences of addiction.

What does the self-medication theory consist of?

While studying his patients, Khantzian observed that all of them had consumed at least three different psychoactive substances before developing the dependence or addiction they were going to be treated for. At that moment, the author wondered why they chose those drugs instead of different ones. Then, he came to a conclusion. Depending on the underlying psychiatric disorder that each patient suffered from, they chose the drug that relieved their psychopathological symptoms the most. 

For example, a shy businessman turned to alcohol to increase his sales. Likewise, a teenager with anger issues ended up consuming heroin to better control their impulses. They all tried drug after drug, until finding the one that was most effective for them. But, of course, the abusive consumption of the substance ended up producing another problem: addiction. 

As of now, to establish the diagnosis of substance use disorder according to the DSM-V, patients must present two or more of the following criteria for a period of at least 12 months: 

• Consumption of large quantities of substances for a longer period than expected.
• Insistent desires to regulate or stop the consumption, plus failed efforts to quit.
• Investing a lot of time trying to get the drug, consuming it, or recovering from it.
• Intense desire to consume the substance.
• Recurring consumption can make them neglect their academic, work, or domestic duties.
• The consumption may continue regardless of the recurring problems it might have caused or exacerbated in their interpersonal life.
• Abandoning important social, occupational, and recreative activities due to the substance consumption.
• Continuous consumption despite knowing that it might exacerbate or originate physical or mental issues.
• Tolerance.
• Withdrawal.

Is there evidence to back the self-medication theory?

As we previously explained, according to the self-medication theory, patients who develop disorders as a consequence of their substance abuse do so because they suffer from psychopathological disorders that, directly or indirectly, lead them to consume substances as a way of self-treatment. 

This hypothesis is based on the discovery of opioid receptors in the central nervous system:

• Any substance can produce an effect on the CNS that involves interacting with specific brain structures.
• The substance itself (such as heroin or cocaine), repeatedly acting on said brain structures, triggers a series of changes that make the individual an addict.

Although this hypothesis was initially proposed for opiates and psychostimulants, it also applies in the case of alcohol. There’s data for and against the self-medication theory. Investigators have found partial evidence in patients with schizophrenia, as well as patients with personality disorders.

In addition to Khantzian’s theory, other hypotheses have historically been considered as well. In fact, the debate is still going on as of now. What’s evident is that every patient is different. Therefore, each patient needs an individual diagnosis and treatment. The fact that this theory is backed by some scientific evidence doesn’t mean that all patients who are drug-dependent have other pathologies.