From Psychology Today:

The self-medication theory of addiction emphasizes that psychological pain is at the heart of addictive behavior and that vulnerable individuals resort to their addiction because they discover that the addictive substance/behavior provides short-term relief and comfort from their suffering (Khantzian, 2018). The theory implies that addiction problems are less about pursuing pleasure than they are about seeking relief from painful feelings. Long-term, addiction becomes an end in itself.

Self-regulation can be defined as the ability to act in one’s long-term best interest. It involves knowing and managing one’s emotions and impulses. The self-medication theory of addiction suggests that individuals with deficits in emotion-regulation skills (i.e., skills relevant for modifying emotional reactions to tolerate negative emotions) use drugs in an attempt to manage negative feelings (Khantzian and Albanese, 2008). Thus, substance addictions function as a compensatory means (for vulnerable individuals) to regulate emotional pain and suffering that otherwise feel unmanageable/intolerable.

Sadly, the addiction problem prevents the user from understanding his or her distress, as well as the development of the emotional capacity to self-soothe. They are less likely to grow and develop the psychological capacity to meet life challenges (e.g., self-esteemrelationships, and self-care).

From the self-medication perspective, addiction is both a solution and consequence of the psychological pains. Drugs are painkillers for treating psychological pain, at least in the short term. The attempts at self-sooth are short-lived and all too often replaced by the suffering associated with addiction. In essence, addicts substitute a misery that is vague and confusing with the misery that is caused by drug use.

The theory of self-medication emphasizes that addictive drugs are not equally appealing. Although a person might experiment with various drugs, they discover that they are drawn toward a certain drug (e.g., stimulants, depressants) because of what it does for them. For example, many cocaineabusers attempt to regulate inner emptiness, boredom and fight depression. Opiates counter intense anger and rage. Alcohol is frequently used as a way of coping with social anxiety. The drinking removes, at least temporarily, the stress of anxiety, and softens rigid defenses. Returning to this relief, again and again, results in addiction.

Thus, the drug of choice might provide clues to the specific psychological problems that are painful for that person. For example, individuals with ADHD are drawn to marijuana and nicotine to calm their anxiety, anger, and depression.

In sum, the self-medication theory of addiction provides a useful tool for the understanding of addiction. The theory focuses on how and why some individuals are vulnerable to addiction. That is psychological distress and suffering increase addictive vulnerability. The intention of drug use is not pleasure, but to find relief from intolerable suffering and pain in the absence of alternatives.

Therefore, treatment has to target the suffering and the person. The crucial step in treatment is to understand the suffering that compels their drug use and explore what the drug does for them. Effective treatment includes developing a capacity to internally sooth themselves – to learn how to tolerate frustration without immediate gratification, or a need to latch on to something outside oneself in order to relieve some deep discomfort.

For example, a recovering alcohol-dependent patient who represses emotions would benefit from learning to acknowledge and manage those emotions. The recovery work includes expanding one’s emotional vocabulary and helping patients to identify/name their feelings. The process of working through upsetting emotional states is a painstaking task. It takes time, patience, endurance, and tenacity. This ultimately turns passive and active suffering into active thinking, problem solving, soothing, and living.

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