The self-medication hypothesis in schizophrenia: what it is and what does it propose

One of the most popular facts in clinical psychology and psychiatry is that patients with schizophrenia tend to have very high addiction rates. Almost half of them consume some psychostimulant substance, be it coffee and tobacco in large quantities or dangerous drugs such as cocaine.

An attempt has been made to explain the reason for this phenomenon, one of the most frequently used explanations being the hypothesis of self-medication, originally proposed to explain drug addiction "simply" but that has been of great importance in explaining these substance disorders in other disorders mental.

Today we are going to explore in depth the self-medication hypothesis in schizophrenia, trying to understand the link between this disorder and the use of illicit substances. Let's go there!

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What is the hypothesis of self-medication in schizophrenia?

Substance abuse is a problem that presents as highly comorbid in schizophrenia. It is calculated that

about 50% of people diagnosed with schizophrenia have some type of substance abuse, a very high percentage compared to 15% in the general population who have addictions or have had them in the past. In other words, patients with schizophrenia are up to 4.5 times more likely to have an addiction.

Any drug can be chosen by this type of patient. In the most severe cases, patients with schizophrenia abuse illicit drugs such as amphetamines, cocaine or cannabis and, in the mildest, the usual thing is that they are heavy smokers and consume huge amounts of coffee or other psychostimulant drinks.

Several factors have been raised and identified as the mechanisms and determinants behind the high comorbidity between addiction and schizophrenia. Among them are social and family aspects, such as family vulnerability, living in an economically depressed environment, having suffered some type of abuse; genetic, such as hereditary predisposition and history of addictions within the family; and problems related to medications to treat schizophrenia, especially side effects.

There are many explanations raised when it comes to better understanding the link between schizophrenia and addiction. Among them, the hypothesis of self-medication stands out, one of the most influential and resounding proposals to explain the relationship between schizophrenia and addictions, and also extrapolating it to other disorders such as anxiety, depression or the disorder bipolar.

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Key insights from the self-medication hypothesis

Although this approach does not stop being what it is, a hypothesis, and therefore still pending to be fully demonstrated, the hypothesis of the self-medication, which is a set of ideas widely disseminated and accepted among psychologists and psychiatrists, having its origins in the work of the group of Khantzian (1985; 1997) and Duncan's (1970s). Within this hypothesis, applied to addictions in general terms, we can highlight the following four approaches.

1. Existence of neurological dysfunction

One of the explanations behind the appearance of an addiction would be the existence of a neurological dysfunction, of genetic or acquired origin, in the neuromodulation-neurotransmission systems at the level of the central nervous system (SNC). This alteration would lead to an alteration in the regulation of analgesia processes, Psychic and organic homeostasis, sexual response, affective life and higher cognitive activity, among other.

The patient affected by such dysfunction would suffer a set of psycho-organic discomforts, which would cause a marked decrease in her quality of life. This person, whose addictive disorder would have an obvious biological cause, if psychoactive substances are found, could initiate a rapid process of dependence if said substances act as a kind of highly "effective" medication for the disorder that he suffers, at least in the short term and according to what he or she thinks.

Your organ dysfunction may have resolved spontaneously or pharmacologically, but if not, this approach argues that specific relapse prevention treatments would be doomed to failure, since sooner or later the patient I would look for that solution again which, although toxic, considers it useful and effective to solve the problems caused by its dysfunction cerebral.

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2. Biological vulnerability

Another of the ideas defended within the hypothesis of self-medication would be a variant of the first, but in this case the Brain dysfunction is not due to any genetic problem or because of an acquired injury, but is due to the existence from a special vulnerability of their neuromodulation-neurotransmission systems to psychoactive substances.

In this way, the use of drugs would generate functional alterations that would dysregulate nervous stability, causing psychological problems in the individual who consumes them. In this case, if psychology and psychiatry do not provide a solution to his problem, the patient would be forced to perpetuate drug use in an attempt to establish his life.

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3. Existence of predisposing factors

A third sub-hypothesis is that there are predisposing factors to the initiation and maintenance of drug addiction, which would be the presence of psychological disorders at the beginning of the behavior addictive. Considering that many illicit drugs have antipsychotic, antidepressant, and anxiolytic (short-term) effects, the self-medication hypothesis suggests that drug addiction patients could actually be patients with other psychiatric conditions who self-medicate, with relative success.

To these patients have a hard time achieving and maintaining abstinence after a detox, due to the incomplete therapeutic action and the annoying adverse effects of the drugs that are prescribed. Among these drugs are neuroleptics, antidepressants and anxiolytics, whose side effects motivate the use of drugs to counteract their effect. It would be this specific explanation that would explain the self-medication carried out by patients with schizophrenia.

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4. Disorders as a result of addiction

The fourth explanation within this hypothesis is a variant of the third, and proposes that mental disorders would be a consequence of the use of psychoactive substances.

That is, there would be patients without previous psychiatric pathology who are vulnerable to the effect psychotropic drug, which would cause them to develop serious long-term mental disorders and difficult remission. Once the substance-induced psychopathological picture has been established, the patient could present compulsive drug use in an attempt to contain symptoms.

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Its application to a pathology such as schizophrenia

According to the hypothesis of self-medication in schizophrenia, people with this disorder end up abusing drugs as a result of their disorder, in the sense that they take psychostimulant substances to manage negative emotions and other problems of the schizophrenia.

Basically, this hypothesis defends that the patient does not take drugs to feel euphoric and happy, but to reduce dysphoria and distress (“bad emotions”) that you suffer, and since he does not know a better way to improve his symptoms, he chooses to consume illicit and toxic substances.

It would also explain why patients with schizophrenia, despite already being treated, resort to other addictive substances. The reason for this would be that drugs would be taken to try to combat the side effects of antipsychotic drugs, such as dysphoric responses or extrapyramidal symptoms.

This hypothesis of self-medication in schizophrenia was gaining much relevance in the late 1980s, although its antecedents can be said to be found in various psychoanalytic formulations proposed during the 1950s. At that time it was already suggested that drugs were used as a coping mechanism against aggressive psychotic tendencies and negative emotions not only in psychotic disorders, but also in people who may appear to be other disorders with depressive symptoms and anxious

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Relevance of the hypothesis

In general terms, the self-medication hypothesis is a formulation, a working hypothesis that allows us to combat the widespread, ingrained and erroneous belief that Drug addictions are merely a "vice", a problem in the personality and temperament of the patient or some fault in his environment that has led to an addiction, such as alcohol, cannabis or cocaine.

The self-medication hypothesis, applied both in schizophrenia and in any other disorder, it exonerates the patient, his family and his environment. Here the "blame" does not fall on parental styles or personality traits, which although they may have influenced the development and maintenance of an addiction, greater importance is given to the fact that drugs are sought to reduce the symptoms of mental disorders or brain injuries, and the weight of possible hedonistic pleasure that may be trying to satisfy the consumer.

Although it is still a hypothesis and therefore a formulation still to be fully demonstrated, it has been truly useful in addressing substance abuse. In one way or another, the self-medication hypothesis has contributed to destigmatize drug addiction, understanding that people addicted to substances are not addicted due to "temperamental weakness" or "due to a lack of values", but rather use drugs as a measure to deal with their problems.

When we meet someone who is addicted or addicted, instead of asking ourselves what the person has done wrong or what wrong influences has been able to receive to fall into addiction, what we should ask ourselves is the role that the drug has in The life of her. We should find out what the substance gives you, what problem it "solves" each time you consume it. Once this is done, a substitute for that harmful substance should be found, in addition to teaching the patient methods healthy and effective in coping with their psychological distress, whether due to schizophrenia or another disorder mental. Only then can the addictive cycle be broken.