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Transcript of Self Medication
Conducted between 1995-1997 by Kaiser Permanente in California
Involved over 17,000 participants
Looked at the correlation between Adverse Childhood Experiences in relation to subsequent physical and mental health issues, and development addictions
SMH: the Self Medication Hypothesis
Concept originally founded in 1974 by L. Wurmser, and later evolved into SMH in 1985 by co-founders Edward Khantzian, Mack and Schatzberg, and David F. Duncan
Absolves the addicted individual of excessive blame
Avoids the stigma of "disease"
Gives control or "agency" back to the addicted individual
Wikipedia defines self medication as: "a human behavior in which an individual uses a substance or any exogenous influence to self administer treatment for often un-managed, undiagnosed physical or psychological ailments."
Defining Addiction: Disease, Choice, or Self-Medication?
Khantzian takes a psychodynamic approach to self-medication
Duncan's model focuses on behavioral factors such as positive and negative reinforcement, and avoidance of withdrawal symptoms
Divisions OF SMH
The Adverse Childhood Experiences (ACE) study found multiple, dose-dependent relationships between severe childhood stress and all types of addictions, including overeating.
In 1985, psychologist W. L. Cox and others proposed that there was no scientific evidence to support SMH
Sigmund Freud's theories regarding the Ego, Super Ego, and the Id
Substance or behaviors are used as
"ego solvents", or to compensate
for a deficient ego
Two Necessary Components:
The addictive search
The adventitious entrance of chemicals
I get by with a little help from my friends....
promotes the wrong intervention strategy for individuals with co-occurring psychiatric and substance use disorders,
encourages clinicians to target only the “underlying” psychiatric illness and ignore addiction assuming that once the depression or mania or anxiety or whatever is treated, the substance use problems will resolve,
encourages patients to interpret all psychological suffering, e.g., depression, anxiety, irritability, poor concentration, as originating from the underlying psychiatric disorder rather than from dependence on or withdrawal from addictive substances, and
allows addicted patients to deny the negative impact of substance use, rather than encouraging them into behavioral change.
Proposed Models of Treatment
Cognitive Behavioral Therapy
Dialectical Behavior Therapy
According to Cox,
there are 3 pre-existing character traits: