Further Evidence of Self-Medication: Personality Factors Influencing Drug Choice in Substance Use Disorders

Abstract

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and display lower levels of emotional inhibition. MANOVAs were used to test three hypotheses regarding drug group differences on the personality variables that were in keeping with the SMH. The MANOVAs for Hypothesis I (Depressant group) and Hypothesis II (Opiate group) were statistically significant. Findings partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.

An Ecodevelopmental Exploration of Mediators Between Maltreatment in Childhood and Drug Use During Pregnancy

“…More recent research has also found that factors such as anger (Faulkner, Goldstein, & Wekerle, 2014), behavioral undercontrol (Oshri, Rogosch, & Cicchetti, 2013), and depression (Walsh & Cawthon, 2014) may mediate associations between maltreatment and later substance use. Such findings are consistent with suggestions that substance use can be partly driven by a need to cope with negative emotions (Khantzian, 1997; McKernan et al, 2015), and that it is more likely among persons with poor behavioral control (Zucker, Heitzeg, & Nigg, 2011). Notably, these findings are also consistent with suggestions noted earlier that early maltreatment can lead to emotional dysregulation (Kim & Cicchetti, 2010).…”

The association of psychiatric symptomatology with patterns of alcohol, tobacco, and marijuana use among Brazilian high school students

“…This specific population of individuals with subclinical scores may be a potential target for clinical interventions, even though their clinical score is not positive yet. We speculate that their current substance use might be masking their actual mental health status . Moreover, both subclinical and clinical positive scores were associated to past‐month use, but not to frequent use.…”

Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory

“…This paper focuses only on the first assumption because it offers an explanation for the link between substance use and psychological distress. Readers interested in the second assumption can refer to Khantzian and others (Khantzian 1985; Khantzian 2003; Khantzian 1997; Suh et al 2008; McKernan et al 2015). …”