The term “self-medication” has trivial and negative connotations. Many would use it as a joke about using alcohol or drugs as a coping mechanism. However, “self-medication” has become a household term that detracts from the real emotional suffering that accompanies addiction. Although the theory behind self-medication (Self Medication Hypothesis) has been widely studied, it is still not given enough serious attention as an explanation for addiction.
Self Medication Hypothesis (SMH)
If someone is self-medicating, there are many negative and dismissive reactions. Often, such behavior is met with criticism or judgement. Reactions from family and friends, and society’s stigma furthers the shame and guilt of addiction. Dr. E.J. Khantzian of Harvard Medical School takes a more emotional approach. Instead of asking why someone uses drugs he asks, “What did the drug do for you?” This question opens up a dialog with empathy, rather than judgment.
Self Medication Hypothesis (SMH) was first officially published in 1985 in the American Journal of Psychiatry. Initially, it focused on how and why people become dependent on heroin and cocaine. The underlying theory was that addiction can come from painful emotions that were not properly dealt with. The hypothesis has been studied with over 5 decades of clinical evaluations. Despite its solid research basis, however, it has been trivialized and dismissed. The modern research paradigm focuses on the physiological explanations for addiction.
Psychological vs Physiological Causes
So little is still known about the roots of addiction despite so much research on the subject. Recent studies have leaned on neuroscience for answers. These studies categorize addiction as a “primary disease” because of a drug’s ability to “hijack” the brain. The drug creates new neural pathways in the brain and, therefore, explains the physiological and relapse elements of drug addiction. But with so many physical explanations for addiction, what about psychological appeal of addictive drugs?
Feelings like fear, sadness, anxiety and anger can be powerful and governing emotions in our lives. Coping with these strong emotions is the foundation of how we regulate ourselves. It can be the basis for our self-esteem, as well as how well we relate to others. These emotions are especially important for our self-care. The emotions used for self-care guide us away from unnecessary risk or danger, but are often underdeveloped in those prone to addiction.
“It is not so much that these individuals seek euphoria, but rather the aim is relief of dysphoria. It is not surprising that individuals with any of these conditions could become attached to the powerful change in emotional state that drugs can provide, especially persons who are prone to addiction.” – Dr. E.J. Khantzian, Professor of Psychiatry, Harvard Medical School
Painful and stressful feelings can be powerful motivators. While some feel them as intense and distressing, others might see them as confusing or inaccessible. Exploration and understanding of critical feelings related issues that predispose one to addiction. Co-occurrence of disorders were rage or anger predominate (PTSD, bipolar, borderline personality disorder) and opiate addiction is too disproportionately high to ignore, says Dr. Khantzian.
The emotional roots of addiction can seem like they are being overlooked. Many researchers are looking for physical explanations for addiction, but forget its root is deep in emotion. Trauma and painful experiences can often prompt self-medication, which can quickly lead to addiction.