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Sunday, November 20, 2011

"From Self-Medication to Intoxication: American Culture's Addiction to No-Suffering"

Psychiatry Grand Rounds, Herrick Hospital:  A Critique of the Self-Medication Hypothesis by Anna Lembke, MD, Stanford University
Held on November 7, 2011

Since 1985, when Edward Khantzian came up with the concept of addiction being the result of self-medication (i.e., the individual doesn't feel right so they use street drugs/alcohol to experience more balance), it has been in usage by most therapists and has become commonly believed.   

The addict or substance abuser  asks for treatment of his personal problems believing this (assistance with resolution of emotional distress) will make it possible to give up the chemical use.  The assumption is that early childhood trauma or an extremely distressing life event, internal psychological suffering or psychiatric symptoms, triggered the addictive use of alcohol or drugs.  However, it turns out, according to Dr. Lembke, who has reviewed hundreds of studies, testing this hypothesis, that there is no evidence for this idea.  She proposes that the evidence shows a substance use disorder to be an independent problem.
This, despite the fact that there is a high rate of co-occurrence.  For example, those diagnosed with an anti-social personality disorder show an 80% rate of substance use disorder, those with bipolar 1 disorder have a 60% co-occurrence rate, and schizophrenics have been found to have a 50%  rate of substance use disorders, while the "regular population" has a rate of 15%.  Nonetheless, a case cannot  be made for someone using a particular substance because it addresses their specific disorder since some of the studies tested what people would do given the free option to choose and full access to mind-altering chemicals.  It turns out, we humans all like the same things.  

People, according to this presentation actually get involved with substances due to either boredom (often the case with marijuana) or to the idea that all suffering should be eliminated and that to take a pill is the way to get rid of it.  Actually, the evidence is for the  reverse; stopping substance abuse leads to healing, it turns out
Dr. Lembke suggests, as did Joan Zweben (see earlier post:, that individuals who are having trouble with the overuse of a substance, experiment with not using. She suggests  4 weeks (the amount of time needed for the brain to reach a new homeostasis) and then to follow that with an evaluation:  
What was different?  What was better?  Was anything worse?  Etc.

The best treatment targets both disorders (whatever is personally troubling the individual as well as the substance use disorder).  It should be an integrated treatment, not one in the absence of the other nor one first and then the other.  Dr. Lembke feels it is possible to help anyone and that "...self-medication is not medicinal."

(The illustration from an artwork by Michael Parkes, titled See No Evil, I chose because the problems discussed here are so hard for many people to talk about and therefore sometimes shame is felt about one's use of substances which can lead to denial)

This point of view is different from what is usually put forward on this topic; do you have any comments?


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