Self-medication theory, as mainly advocated by Ed Khantzian, assumes that suffering is the driving force behind addiction. The theory hypothesizes that underlying psychological disorders force individuals to self-medicate.
Patients are then distinguished as per their drugs of choice. For instance, if a patient had an alcohol use disorder, he or she might have been battling social anxiety and were self-medicating for performance anxiety, shyness or nervousness in social settings.
However, critics argue that not all addictions are a result of underlying psychological disorders: substance abuse damages the brain and can actually be a cause of psychological issues rather than a result in many cases.
While depression can make a person more susceptible to an alcohol use disorder, the inverse is quite common as well. This is because alcohol acts as a depressant. Cocaine causes psychiatric diseases which included prominent symptoms of suicidal thinking and depression.
Methamphetamine is a prominent example of drugs that lead to psychiatric and neurological disease. In fact, research shows binging on methamphetamine to cause concussion-like states similar to traumatic brain injury.
Furthermore, there are numerous examples of patients suffering from a psychological disorder for years and have no history of substance abuse.
Important factors to consider
Substance abuse disorders may seem easier to identify and categorize, but it’s just as complicated to understand in terms of treatment and long-term recovery. This warrants a more in-depth exploration into the effects and functionality of the drug itself, alongside assessing the patient with an all-encompassing approach.
The toxic effect of substances of abuse on the brain and the nervous system, called neurotoxicity, varies across patients. Toxicity levels depend on the drug itself, the age of the user, route of administration (e.g., smoking or intravenous), the dosage of drug consumed, duration of abuse, genetics, neurotoxic effects, and residual deficits.
The discussion is, however, incomplete without understanding the users and their vulnerabilities. It is vital to identify a dual diagnosis, if such is the case, treating the patient simultaneously for underlying psychiatric and/or medical, neurological, endocrinological, cardiological, infectious and other diseases. Past histories of sexual, emotional and/or physical trauma significantly influence addiction and long-term recovery.
The assessment is further complicated by the fact that genes and gene activity at conception may not be the same as at birth or in childhood or further ahead in life. Children of opium-smoking parents often demonstrate toxic levels of opium in their bodies.
Second and third-hand exposure, such as for second-hand smoking, allows numerous harmful chemicals to be administered through breath, regardless of consent. Growing up in an environment with drugs in the air or water is also a risk factor to consider.
Individuals also hold extraordinary sensitivities to particular substances. Patients sometimes hear voices and became psychotic when given a dose of amphetamine that most other patients may not even detect.
Other personal characteristics such as age, social status, financial well-being, unemployment, LGBT, risk-taking behaviors and age at initiation of abuse all play influential roles in maintaining long-term recovery.
Loss of brain function
All drugs of abuse target the brain, interact with existing brain receptors and circuits, alter brain functioning and undermine the routine functioning of the brain. Yet, not everyone has noticeable losses in brain function. Some drugs cause more damage, like methamphetamine, whereas some methods of administration cause more loss of brain function, such as intravenous use.
Such damage is particularly noticeable during evaluations of addicted medical professionals. The loss of intellectual skills, motor skills and other decrements in a proven premorbid baseline has led Boards of Medicine to ask for impaired physicians to have “fitness for duty” evaluations and medical board, before clearing them to return to their profession.
Such skill evaluations at the University of Florida of physician addicts frequently documented the loss of higher brain functions and skills.
Substance abuse, depression, and suicide
Drugs of abuse influence the brain’s reinforcement and mood circuits. Dopamine systems are disrupted, and dopamine levels are reduced, all the while raising the brain reward stimulation thresholds.
Psychostimulant Drug withdrawal is also commonly associated with depression. This withdrawal is the abstinence syndrome, psycho-motorically retarded depression, most commonly seen in cocaine addicts.
Drug use is commonly associated with an increased risk of suicidal thinking. Anhedonia, depression, and despair often co-occur in OUDs and have been suggested as a cause of the current overdose epidemic. Suicide rates have increased in nearly every state over the past two decades, and half of the states have seen suicide rates go up by more than 30 percent.
In addition, rates of emergency department visits for non-fatal self-harm, a primary risk factor for suicide, increased by 42 percent. Two-thirds of suicide completers had a history of treatment for mental health or substance use disorders, with approximately half in treatment when they died of suicide.
Focusing on the patient
Yet, in cases of dual disorder and determining treatment, these chicken or egg arguments don’t hold much importance. Dual disorders are best treated if both are identified and treated simultaneously.
Patients with a dependence may detox and successfully complete a 12-step program only to find they never truly recovered. Overwhelming sadness, despair, anhedonia, and depression keeps undermining recovery.
Ed Khatzian has extended the self-medication hypothesis to facilitate a comprehensive interviewing of patients. It offers a good start to understanding a patient’s addiction history.
It invites an open discussion and allows both addictive and psychiatric histories to be elicited by the health provider. This helps highlight the barriers to recovery including attachments to certain drugs for reasons only the addict may have.
Despite the importance of drug history, an all-inclusive approach that treats the patient as an independent entity is the key to comprehensive evaluation and individualized treatment plan.
It is just as important to know about the drug or drugs, route of administration, dose, and duration to evaluate co-occurring risks for infectious diseases, cardiovascular diseases, STDs as it is to understand mood, anxiety, sleep, relationships, trauma and other behavioral aspects of addictions.
About the Author:
Mark S. Gold, M.D. served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD
About the Transcript Editor:
A journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.
Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.
1. http://www.psychiatrictimes.com/addiction/theory-self-medication-and-addiction; Khantzian, E. J.
2. Gold MS, Kobeissy FH, Wang KK, Merlo LJ, Bruijnzeel AW, Krasnova IN, Cadet JL.Methamphetamine- and trauma-induced brain injuries: comparative cellular and molecular neurobiological substrates.
5. Mark Gold, 800 Cocaine, Bantam Books, 1984.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published on September 4, 2018
Reviewed by Jacquelyn Ekern, MS, LPC on September 4, 2018
Published on AddictionHope.com