Am J Psychiatry 1985; 142:1259-1264
Copyright © 1985 by American Psychiatric Association
The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence
EJ Khantzian
Recent clinical observations and psychiatric diagnostic findings of
drug-dependent individuals suggest that they are predisposed to addiction
because they suffer with painful affect states and related psychiatric
disorders. The drugs that addicts select are not chosen randomly. Their
drug of choice is the result of an interaction between the
psychopharmacologic action of the drug and the dominant painful feelings
with which they struggle. Narcotic addicts prefer opiates because of their
powerful muting action on the disorganizing and threatening affects of rage
and aggression. Cocaine has its appeal because of its ability to relieve
distress associated with depression, hypomania, and hyperactivity.
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