Since the existence of the human being, the search for medicinal plants or the desire to consume substances for treatment or entertainment are notable activities. It may even be the seed that has made it possible to know and consume today a great variety of psychoactive substances.
This habit is part of the beliefs and ideas of each era because it is related to health and illness. For example, at the beginning of 20th It was considered that an addict was a despicable and lazy person who lacked the will to control his impulses.
Khantzian, a psychoanalyst who worked with addicts at Harvard University, began to identify the purpose and purpose of these people when they consume such substances. This author developed the theory of self-medication that the main cause for consuming these substances is actually a person's inability to tolerate negative states.
At the moment,addiction to psychoactive substances is a major public health problemit has an impact on society and has social, legal and political consequences. For this, every day, every effort is made to understand the causes and consequences of this disorder.
What is the theory of self-medication?
Khantzian made an observation while studying his patients: they had all consumed at least three different psychoactive substances before developing addiction and addiction. The author then wondered why these individuals had chosen this substance and not another. He came to a surprising conclusion: according to the psychiatric disorder of each patient, a drug or another was chosen to relieve psychopathological symptomatology as much as possible.
For example, a shy businessman used alcohol to increase sales. In the same way, a teenager with problems of aggression ended up consuming heroin to better control his impulses. All of these individuals intuitively tested one drug and then another until they found the one that seemed most effective to them. Obviously, this abuse of substance ended up causing a problem with a specific entity: addiction.
According to the DSM-5
Currently, To diagnose substance use disorder in DSM-5 we must identify at least two following criteria for a period of 12 months:
- Consumption of large quantities of substances or for longer than expected
- Insistent desires to regulate or stop consumption and inconclusive attempts
- Lose a lot of time to get the drug, consume it or recover
- Intense desire for consumption
- Recurrent consumption can lead to non-fulfillment of tasks in academic, professional or domestic
- Consumption continues despite recurring problems in the interpersonal sphere caused by the effects of this consumption
- Reduction or abandonment of social, entertaining or professional activities because of the consumption of substances
- Probable occurrence of recurrent consumption of the substance even when it involves a physical risk
- The person consumes continuously even knowing that she suffers from a physical or psychological problem that may be caused or aggravated by the consumption in question
What evidence exists around the theory of self-medication?
As we explained earlier, this theory is based on the fact that patients who develop the substance use disorder do so because they suffer from psychopathological disorders. The latter push them, directly or indirectly, to consume substances as a form of self-treatment.
This hypothesis is based on the discovery of opioid receptors in the central nervous system:
- Any substance produces an effect in the central nervous system that involves the interaction of specific brain structures
- The substance in question (heroin, cocaine) acts repeatedly on these brain structures and causes a series of changes that makes the individual dependent
Although this hypothesis has initially been presented for opiates and psychostimulants, it is also applicable to the case of alcohol. There is evidence against the theory of self-medication. Partial evidence has been found in schizophrenic patients and persons with personality disorders.
In addition to Khantzian's theory, other hypotheses have historically been presented. In fact, the debate continues today.It is clear that not all patients are identical and each requires a diagnosis and individualized treatment. The fact that this theory has shown some scientific evidence does not mean that all addicted patients suffer from a pathology.