Self-Medication Hypothesis of Substance Use: Testing Khantzian's Updated Theory

Abstract

Substance use research has been a salient focus for mental health professionals in recent years. Several organizations, including the American Psychological Association, have been pressing for more substance use research, particularly clinically relevant, theory-based investigations. However, there are few theories of substance use, and even fewer with scientific support. One theory is the Self Medication Hypothesis by Khantzian (1977, 1974), a theory with 30 years of research. However, recent modifications in Khantzian's theory (1999) have not been properly tested. Specifically, two areas require further investigation: Khantzian's belief that more negative affect should be related directly to more substance use, and expanding the number of affective states examined, including alexithymia, to better operationalize Khantzian's belief that several painful and ambiguous forms of affect may be implicated in the self-medicating process. The current study assessed anxiety, depression, hostility and alexithymia levels in 70 methadone maintenance treatment patients. Results indicated that affective measures did not have the expected relationship with reported substance use. The authors advocate for the exploration of multiple factors, not merely emotional regulation, in the variability of substance use.

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

“…Multiple empirical investigations of drug specificity according to the SMH could not support this aspect of the hypothesis (Aharonovich et al, 2001;Castaneda, 1994;Greene, Adyanthaya, Morse, & Davis, 1993;Hall & Queener, 2007;Weiss et al, 1992). An early investigation linking personality traits to drug use found distinct personality differences among drug users, particularly among barbiturate users, who displayed higher levels of emotional distress and reported decreased anxiety following drug use (Crain, Ertel, & Gorman, 1975).…”

“…Studies (Aharonovich et al 2001;Castaneda, 1994;Hall & Queener, 2007) based drug of choice on self-reported use. According to a 24-study meta-analysis of self-reported drug use among highrisk populations, self-reported drug use is extremely unreliable (Kappa = .42), variable, and under-reported, particularly in post-treatment follow-up visits and out-of-treatment populations (Magura & Kang, 1996).…”

Momentary affective states predicting substance use events in depressed youth

“…Armeli, Tennen, Affleck, & Kranzler, 2000;Hussong, Hicks, Levy, & Curran, 2001;McCreary & Sadava, 2000), ''stress-response dampening'' (Armeli et al, 2003), or ''self-medication'' (e.g. Colder, 2001;Hall & Queener, 2007;Hussong, Gould, & Hersh, 2008;Swendsen et al, 2000). Cooper et al (1995Cooper et al ( , 2000 have also posited that substance use may at times serve to enhance feelings of well-being and positive affect (PA), particularly for those ranking high in trait extraversion.…”

Differentiating Between the Course of Illness in Bipolar 1 and Chronic-Psychotic Heroin-Dependent Patients at Their First Agonist Opioid Treatment

“…[27][28][29] This hypothesis is supported by the fact that, among substances of abuse, opioids do not seem to have a psychopathological effect. 30 Despite the fact that the "self-medication hypothesis" is well accredited in the literature, 31,32 with few exceptions, 33 the studies only partly concur with it. First of all, it has been found that the majority of drug-dependent patients seeking treatment in Italy had developed mental health problems subsequent to developing heroin dependence, while the selfmedication theory of dual diagnosis was relevant only for those with existing diagnoses of chronic psychosis or anxiety disorders; 1 second, in the bipolar heroin-dependent patients entering treatment, besides one expected resultthe prominent use of central nervous system (CNS) stimulants during a depressive phasethe use of non-prescribed anxiolytic-hypnotics during depressive phases, and the use of cocaine-amphetamines during manic-hypomanic phases, support the hypothesis that mood elation is a pleasurable, rewarding experience that, in bipolar patients, can be started or prolonged by means of CNS-stimulating drugs.…”