Revisiting the self-medication hypothesis from a behavioral perspective

The self-medication hypothesis suggests that clients use substances as a me ans to reduce their psychiatric symptoms. However, substance use as a form of self-medication also can be interpreted as exacerbating symptoms. Behavi oral Principles may provide a useful perspective to understand this apparen t contradiction. The authors investigated the relationship of types of subs tance use with psychiatric symptoms among 220 participants with co-occurrin g disorders in an acute care psychiatric unit. Participants were assessed f or their use of 6 different classes of substances within 3 months of admiss ion. Hierarchical logistic regression analyses found that particular substa nces were associated with each of the diagnostic categories and that the Pa ttern of associated substances differed by diagnostic category in a way tha t 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.