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The Self-Medication Hypothesis

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Spring/Summer 2002


Welcome to the Spring/Summer 2002 issue of SMH.

In this issue we examine two recent surveys of drug use in the United Kingdom, a call for primary care

physicians to become more involved in treating addicts, and the applicability of the self-medication hypothesis to nicotine addiction, We also include a listing of upcoming meetings in the addictions field.


Thirteen Million Britons Have Taken Illegal Drugs


London (Reuters, April 21, 2002) - More than half of all young people in Britain and 28 percent of the whole population -- about 13 million people -- have taken illegal drugs, increasing pressure for reform of narcotic laws, The Observer reported in a special issue titled "Drugs Uncovered".

An ICM poll for the newspaper found that 51 percent of the nation's 16 to 24-year-olds had taken banned drugs, while five million people regularly used cannabis, and more than two million regularly took ecstasy, amphetamines and cocaine.

"We are not surprised. The threat of criminal sanctions is simply not stopping large numbers of young people experimenting with drugs," Roger Howard, chief executive of the charity Drugscope, told The Observer.

The issue of drugs has become a hot political topic in Britain in recent months. A pilot scheme in south London, sees officers overlooking cannabis users and concentrating instead on dealers in destructive drugs such as heroin and cocaine. The experiment, which began last July, has been heralded as a success.

Last October the government announced it would reassess its traditional tough line on drugs. Home Secretary David Blunkett said he intended to relax the law on cannabis by making possession no longer an arrestable offence. Some senior politicians and Britain's former chief inspector of prisons have even called for some, if not all, drugs to be legalised and made available on prescription.

The ICM poll was based on a survey carried out in February and March of 1,075 people aged over 16.

The full report of the survey and related articles in

The Observer can be found at:,11908,686419,00.html

Some of the addict accounts in the reports illustrate the role of self-medication in addiction. For instance, the history of heroin addict Giles in "Can You Kick It?":

Initially at least, heroin dealt with the terror that gripped Giles in dealing with everyday life. 'It took the fear away that's always in my chest and would always sink to my stomach. That adrenaline that's always there trying to come out of the back of your throat. That awkward feeling, never wanting to go into a shop in case something went wrong and you got embarrassed. It just gave me the confidence to really be me, although, of course, I wasn't me.',11908,686716,00.html

The Observers survey reinforces the findings of the charity Alcohol Concern which reported last year in its State of the Nation report that

1 person in 13 is dependent on alcohol in Britain twice as many as are hooked on all forms of drugs, including prescription drugs (1 in 26). . . .

Yet just over 1 million is spent on alcohol prevention and treatment compared with 91.45 million on drugs while the drinks trade spends 227 million a year to advertise its products.

For more information on Alcohol Concerns report on The State of the Nation see



Do More For Drug Addicts, British GPs Told


London (British Medical Journal, March 2, 2002, Vol. 324, p. 501) According to a report from British health authorities, more general practitioners (GPs) need to get involved in providing care for drug misusers if the government's plans to overhaul and expand current drug rehabilitation services are going to succeed.

Although some drug treatment services are excellent, the report says, most are poorly organized, offer only limited treatments, and are understaffed. Many have such long waiting lists (up to 100 days in some areas) that more than half the patients never show up when their turn comes, and because after-treatment support is poor, many patients "fall through the net" and are never heard of again.

The British government has allocated an extra $240 million during the next two years and has set up the National Treatment Agency to improve the quality of care and access to it. But for this additional funding to make a difference, services need to be urgently reviewed and better coordinated and staffed, says the report.

Many GPs are reluctant to take on the care of these patients. A survey of more than 1500 GPs found that those responding felt they did not have sufficient training to manage drug-dependent patients, 74% specifically lacked confidence in their ability to work with opioid abusers, and 66% believed treating opioid misusers required therapeutic skills beyond the competence of GPs.

The report, "Changing Habits: The Commissioning and Management of Community Drug Treatment Services for Adults" is available at


Nicotine Addiction May be Motivated by Attention Problems


Washington, D.C., U.S. (Nicotine and Tobacco Research) A new study shows that people who have difficulties paying attention may smoke to sharpen their focus, according to a study by researchers at the Center for the Advancement of Health.

The leader of the research team Dr. Caryn Lerman, of the University of Pennsylvania Cancer Center, points out that patients with attention defecit/hyperactivity disorder have a well-documented tendency to smoke. The researchers found that tobacco's stimulating effects help hyperactive people to manage their symptoms and allow them to be more focused. The more severe a smoker's attention problems, the more likely they are to use tobacco as a form of "self-medication." Some chronic smokers were also found to use tobacco to relieve symptoms of depression.

As a result of the study's findings, Dr. Lerman suggested that simple screening procedures could be used to identify smokers entering cessation programs who may have more difficulty quitting smoking, and to tailor treatments to address their specific needs for symptom management alternatives to nicotine.


More on Smoking as Possible Self-Medication


Santa Monica, Cal., U.S. (Rand Newsletter) Empirical evidence regarding the causal nature of the relationship between emotional distress and tobacco use in male and female adolescents provides support for both the distress-to-use (self-medication) and the use-to-distress
hypotheses. Using a cross-lagged model with 3 waves of data from 2,961 adolescents followed into young adulthood, the authors tested the hypothesis that this relationship changes over time. As hypothesized, emotional distress in Grade 10 was associated with increased smoking in Grade 12 for both boys and girls. Smoking in Grade 12 was in turn associated with increased emotional distress in young adulthood. The addition of 3 third factors (rebelliousness, deviance, and family problems) to the model did not
alter the results. Results suggest that the relationship between tobacco use and emotional distress is a dynamic one in which distress initially leads to use but then becomes exacerbated by it over time.

Maria Orlando, Phyllis L. Ellickson, Kimberly Jinnett. The Temporal Relationship Between Emotional Distress and Cigarette Smoking During Adolescence and Young Adulthood. Journal of Consulting and Clinical Psychology, vol. 69, no. 6, 2001.

A copy of this paper (identified as RAND Document #RP-997) can be requested free from The RAND Corporation at their website,




Upcoming Meetings



Adolescent Substance Abuse: Theoretical Constructs and Practical Solutions

May 16

Wills Hall, University of Bristol

Bristol, United Kingdom

Info: Dr. Ian Sutherland
Adolescent Assessment Services
49 Beaufort Drive
Kittle SA3 3LD

Tel: 01792 232789


Tackling Alcohol-Related Crime and Disorder

May 29, 2002

The Grange Holborn Hotel, London, WC1B, United Kingdom

Sponsor: Crime Concern, Crimestoppers, and Police Oracle

Info: Neil Stewart Associates at




Pain & Chemical Dependency
June 6-8
Sheraton Hotel/Towers; New York, NY, USA
Contact: 404-233-6446 or

College on Problems of Drug Dependence (CPDD)
June 8-13
Hilton Quebec, Quebec, Canada
Contact: 800-759-5800 or





1st Annual New England School for Treatment of Opioid Dependence
July 7-11, 2002
Newport, Rhode Island
Contact: Jessica Gogan, 207-621-2549 or




31st UCSD Summer Clinical Institute in Addiction Studies
August 19-22
San Diego, CA
Contact: Tracy Wilson, 851-551-3182 or http://




Addictions 2002

September 15-17

Eindhoven, The Netherlands

Contact: Karen Purvis
Blue Zulu Marketing
The Old Farmhouse

15 The High Street

Ascott-under-Wychwood, Oxon OX7 6AW, UK
Tel / Fax: +44 (0) 1993 831859






European Drugs Conference 2002

Drugs and Society: Implementing the Changing Agenda

October 24-25

Ashford International Hotel, Kent, United Kingdom

Sponsor: the Home Office, Kent County Council, University of Amsterdam, and University of Kent.

Contact: Pavilion Tel 01273 623222 Fax 01273 625526 or





Society for the Study of Addiction

2002 Annual Symposium

Queens Hotel

Leeds LS1 1PL, United Kingdom

November 28-29