The validity of Khantzian’s self-medication hypothesis in new addictions
Pathological addictions and new addictions have several characteristics in common. Scientific research indicates that the hypothesis is increasingly credible that in addictions without the use of substances, as well as in drug addictions, the behavior implemented by those who suffer from it is an attempt at self-treatment.
Advertising message The World Health Organization describes the concept of pathological addiction like that
Today the term pathological addiction is also used to describe a group of disorders characterized, not by substance abuse, but by a spasmodic search for behavior or an object, without which the person’s life becomes problematic or unsustainable. Reference is made to the so-called new addictions, related to new technologies, compulsive shopping, gambling addiction, work addiction, food addiction, or emotional addiction. Addiction and addictions affect a large number of people in the world and are united by several aspects:
It is then legitimate to think that drug addictions and addictions have a common etiology, which are determined by the same cause.
One of the etiological hypotheses to explain the onset of substance addictions is that formulated in the seventies of the last century by Edward Khantzian and David F. Ducan and known as the self-medication hypothesis. Initially Khantzian started from the idea that drug addicts were individuals characterized by a deficit in ego functions and that drug research represented an attempt to enhance its defense mechanisms. Subsequently, considering the case studies of the subjects he treated, the question arose whether the choice of the psychoactive substance was random. He came to the conclusion that the type of drug was selected in such a way that the pharmacological properties of the substance were suitable for alleviating the disturbing affective states of the subject.
There are some experimental studies supporting the theory of self-medication, among which the one conducted in 1977 by Wusmer L. and Pecksnifr Mr. is particularly interesting. It is a research in which a group of heroin addicts was treated with doxepine and compared to a group placebo-treated control panel. Doxepine resulted in a significant reduction in craving. The authors concluded that the heroin addicts were suffering from anxiety-depressive syndrome that went into remission as a result of treatment with the antidepressant drug. As reported, also, by Rounsaville et al (1982), the substance abuse disorder responds to appropriate treatments with psychotropic drugs against target syndromes such as phobia and depression.
Finally, there is clinical evidence to support the self-medication hypothesis, which concerns individuals dependent on opiates and sedative-hypnotic drugs.
All these data confirm Khantzian’s hypothesis that depressed drug addicts use opiates in an attempt to cure an intolerable state of mental illness.
As far as new addictions are concerned, it has been hypothesized that Khantzian’s theory may also be valid for these addictions.
Advertising message Several studies suggest that the brain mechanisms underlying obesity are similar to those of drug addiction and consequently obesity is to be considered as the result of a dependence on food. A group of researchers from the University of Granada, together with researchers from the Australian Monash University, conducted a study to test this hypothesis. Differences between functional connections in reward systems in the brain of obese and normal weight researchers were researched. The research made use of functional scans made with magnetic resonance imaging which showed that the desire for food is associated with the activation of different neuronal connections, depending on whether the person is of normal weight or overweight. Research conducted by a group of researchers from the University of Alabama at Birmingham (USA) and published in the American Journal of Public Health has identified a correlation between depression and obesity. The researchers used data from a very large study called CARDIA (Coronary Artery Risk Development in Young Adults), which monitored for 15 years, a group of young adults, men and women, aged between 18 and 30 years. It has been shown that those who showed depressive tendencies (levels measured at 10, 15 and 20 years), gained weight, increasing their abdominal circumference faster than the others; while those who were already overweight did not show any worsening on mental balance.
In pathological gambling a study conducted by Gianni Savron et. al and published in 2001 in the Journal of Psychiatry has shown how pathological players have greater sensitivity to anxiety and greater distress than controls. Shinohara et al. (1999) observed an increase in beta-endorphins, adrenaline and dopamine at the start of the game and during the game.
Data from epidemiological studies on internet addiction show how risk factors in young people are represented by psychological, psychiatric or family problems that existed before the onset of the disorder. Marazziti et al. (2015) report that mood disorders and anxiety are among the most frequent. For adolescents, elements of particular vulnerability are low self-esteem, which various studies correlate with a greater probability of developing depression, in addition to insecure identity and weak social skills. Finally, in adults, there are often problems of loneliness, dissatisfaction in marriage, work-related stress, depression, insecurity due to physical appearance and anxiety.
There are several reasons to think that compulsive shopping may be a strategy for alleviating an underlying depressive state. The studies of Lejoyeux et al (1996) show that negative feelings of sadness, loneliness, frustration or anger generate an increase in the tendency to shop. Shopping is associated with pleasant emotions such as happiness and a sense of power and competence (Alonso-Fernandez, 1999). Faber and O’Guinn (1992) conducted research that showed that compulsive shoppers have much lower self-esteem scores than regular consumers. For these pathological subjects, shopping could be a way to raise your self-esteem and fight frustration and depressed mood. Confirming the hypothesis of a link between depression and compulsive shopping, there are the results of the study by McElroy et al. (1994) in which nine out of thirteen subjects treated with antidepressants show a complete or partial remission of the characteristic symptoms of compulsive shopping.
The data from scientific studies confirm that drug addictions and addictions have many common characteristics and how it is plausible to think that, even for addictions without the use of substances, there is a link between compulsive behavior and symptoms of depression and anxiety. These evidences make the theory of self-medication very probable and applicable to any type of addiction.