The Self-Medication Hypothesis

The Self-Medication Hypothesis of Substance Use Disorders: A Reconsideration

by Edward J. Khantzian, M.D.
Department of Psychiatry
Harvard University Medical School

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states.

Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing.

Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances.