The Many Faces (and Potential Dangers) of Self-Medication as an Explanatory Concept for Substance Use

  • Michael LevyEmail author


The self-medication hypothesis of addictive disorders maintains that individuals use substances to cope with dysphoric affect, and that painful emotional states are etiologically relevant to the development of a substance use disorder. While this hypothesis may be relevant for some, this paper proposes that self-medication understood in this fashion is an over-used concept. Furthermore, viewing substance use as being caused by some underlying emotional issue will affect how counselling is conducted and it is suggested that intervention may often be misguided. In this paper, other ways that substance use and mental suffering can become related that have nothing to do with emotional anguish being the causal agent for substance use will be elucidated. The implications that this has on counselling intervention will then be highlighted. Broadening of our understanding of self-medication and the many ways that substance use and psychological distress can become linked will help counselors to offer optimal care to this vulnerable population.


Self-medication Dual diagnosis Substance use Addiction Counseling 


  1. Adinoff, B. (2004). Neurobiologic processes in drug reward and addiction. Harvard Review of Psychiatry, 12, 305–320. Scholar
  2. Dick, D. M., Prescott, C., & McGue, M. (2009). The genetics of substance use and substance use disorders. In Y.-K. Kim (Ed.), Handbook of behavior genetics (pp. 433–453). New York: Springer Science + Business Media. Scholar
  3. European Monitoring Centre for Drugs and Drug Addiction. (2013). Co-morbid substance use and mental disorders in Europe: A review of the data. In EMCDDA Papers. Luxembourg: Publications Office of the European Union Scholar
  4. Frances, R. J. (1997). The wrath of grapes versus the self-medication hypothesis. Harvard Review of Psychiatry, 4, 287–289. Scholar
  5. Gau, S. S. F., Chong, M. Y., Yang, P., Yen, C. F., Liang, K. Y., & Cheng, A. T. A. (2007). Psychiatric and psychosocial predictors of substance use disorders among adolescents. Longitudinal study. The British Journal of Psychiatry, 190, 42–48. Scholar
  6. Goswami, S., Mattoo, S. K., Basu, D., & Singh, G. (2004). Substance-abusing schizophrenics: Do they self-medicate? American Journal on Addictions, 13, 139–150. Scholar
  7. Hall, D. H., & Queener, J. E. (2007). Self-medication hypothesis of substance use: Testing Khantzian’s updated theory. Journal of Psychoactive Drugs, 39, 151–158. Scholar
  8. Harrington, R., Fudge, H., Rutter, M., Pickles, A., & Hill, J. (1990). Adult outcomes of childhood and adolescent depression: I. Psychiatric status. Archives of General Psychiatry, 47, 465–473. Scholar
  9. Heath, A.C. (1995). Genetic influences on alcoholism risk. Alcohol Health and Research World 19, 166–171.Google Scholar
  10. Henwood, B., & Padgett, D. K. (2007). Reevaluating the self-medication hypothesis among the dually diagnosed. The American Journal on Addictions, 16, 160–165. Scholar
  11. Kendler, K. S., Jacobson, K. C., Prescott, C. A., & Neale, M. C. (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. American Journal of Psychiatry, 160, 687–696. Scholar
  12. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. Scholar
  13. Kessler, R. C., & Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129. Scholar
  14. Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264. Scholar
  15. Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 287–289. Scholar
  16. Khantzian, E. J., Mack, J. E., Schatzberg, A. F., McKenna, G. J., Treece, C. J., Khantzian, N. J., Kates, W. W., Halliday, K. S., Golden, S. J., & McAuliffe, W. E. (1999). Treating addiction as a human process. Lanham: Jason Aronson.Google Scholar
  17. Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24, 97–129. Scholar
  18. Levy, M. S. (2002). Engaging dual diagnosis clients into treatment: The TEEACH program. Journal of Psychoactive Drugs, 34, 409–413. Scholar
  19. Levy, M. S. (2008). Listening to our clients: The prevention of relapse. Journal of Psychoactive Drugs, 40, 167–172. Scholar
  20. Lo, C. C., Cheng, T. C., & de la Rosa, I. A. (2015). Depression and substance use: A temporal-ordered model. Substance Use and Misuse, 50, 1274–1283. Scholar
  21. Merikangas, K. R., Stolar, M., Stevens, D. E., Goulet, J., Preisig, M. A., Fenton, B., Zhang, H., O'Malley, S. S., & Rounsaville, B. J. (1998). Familial transmission use of substance use disorders. Archives of General Psychiatry, 55, 973–979. Scholar
  22. Meyer, R. E. (1986). How to understand the relationship between psychopathology and addictive disorders: Another example of the chicken and the egg. In R.E. Meyer (Ed.), Psychopathology and addictive disorders (pp. 3–16). New York: Guilford Press.Google Scholar
  23. National Institute on Drug Abuse (2016). The science of substance abuse and addiction: The basics. Media Guide. Retrieved from
  24. Rao, U., Ryan, N. D., Birmaher, B., Dahl, R. E., Williamson, D. E., Kaufman, R. R., & Nelson, B. (1995). Unipolar depression in adolescents: Clinical outcome in adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 566–587. Scholar
  25. Rhee, S. H., Hewitt, J. K., Young, S. E., Corley, R. P., Crowley, T. J., & Stallings, M. C. (2003). Genetic and environmental influences on substance initiation, use, and problem use in adolescents. Archives of General Psychiatry, 60, 1256–1264. Scholar
  26. Schuckit, M. A. (1994). Low level of response to alcohol as a predictor of future alcoholism. The American Journal of Psychiatry, 151, 184–189. Scholar
  27. Schuckit, M. A., & Smith, T. L. (1996). An 8-year follow-up of 450 sons of alcoholic and control subjects. Archives of General Psychiatry, 53, 202–210. Scholar
  28. Schuckit, M. A., Tsuang, J. W., Anthenelli, R. M., Tipp, J. E., & Nurnberger, J. I. (1996). Alcohol challenges in young men from alcoholic pedigrees and control families: A report from the COGA project. Journal of Studies on Alcohol, 57, 368–377. Scholar
  29. Teesson, M., Slade, T., & Mills, K. (2009). Comorbidity in Australia: Finding of the 2007 national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 43, 606–614. Scholar
  30. Vaillant, G. E. (1983). The natural history of alcoholism. Cambridge: Harvard University Press.Google Scholar
  31. Weiss, R. D., Griffin, M. L., & Mirin, S. M. (1992). Drug abuse as self-medication for depression: An empirical study. American Journal of Drug and Alcohol Abuse, 18, 121–129. Scholar
  32. Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 543–553. Scholar
  33. Wilkinson, S. L., Halpern, C. T., & Herring, A. H. (2016). Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood. Addictive Behaviors, 60, 64–70. Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Florida House ExperienceDeerfield BeachUSA

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