Anna Lembke
Publication Details
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Time to abandon the self-medication hypothesis in patients with psychiatric disorders.
Am J Drug Alcohol Abuse. 2012; (6): 524-9
The Self-Medication Hypothesis (SMH) of addictive disorders as articulated by Edward Khantzian in his seminal 1985 paper postulates that individuals with psychiatric disorders use substances to relieve psychiatric symptoms and that this pattern of usage predisposes them to addiction. Khantzian's SMH also postulates that the preferred substance is not random, but is based on the unique pharmacological properties of the substance. For example, an individual with attention deficit disorder would prefer amphetamines to alcohol, due to its stimulating properties, whereas an individual with anxiety would prefer alcohol to amphetamines, due to its anxiolytic properties. Finally, Khantzian's SMH implies that treating the underlying psychiatric disorder will improve or resolve the problems of addiction. AIMS AND RESULTS: A review of the scientific literature demonstrates a striking lack of robust evidence in support of the SMH as put forth by Khantzian.
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