Revisiting the self-medication hypothesis from a behavioral perspective

The self-medication hypothesis suggests that clients use substances as a means to reduce their psychiatric symptoms. However, substance use as a form of self-medication also can be interpreted as exacerbating symptoms. Behavioral Principles may provide a useful perspective to understand this apparent contradiction. The authors investigated the relationship of types of substance use with psychiatric symptoms among 220 participants with co-occurring disorders in an acute care psychiatric unit. Participants were assessed for their use of 6 different classes of substances within 3 months of admission. Hierarchical logistic regression analyses found that particular substances were associated with each of the diagnostic categories and that the Pattern of associated substances differed by diagnostic category in a way that supported both self-medication and symptom exacerbation hypotheses. Self-medication and symptom exacerbation can be defined and treated in cognitive-behavioral terms. Harm reduction strategies seem to offer great promise in this context.