Substance‐Abusing Schizophrenics: Do They Self‐Medicate?

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Abstract
In spite of having been formulated nearly two decades back, there is as yet no consensus on the validity of the clinically popular self‐medication hypothesis (SMH) of substance use disorders in patients with dual diagnosis. SMH broadly proposes that patients use substances in a non‐random fashion so that the psychopharmacologic characteristics of particular substances are used to alleviate a variety of psychiatric symptoms and emotional distress. In order to test the SMH empirically, it was broken down to five sub‐hypotheses, which were tested in a group of dual‐diagnosis schizophrenia (DDS) patients vis‐a‐vis a group of only‐schizpphrenia (S) patients (n = 22 each). The DDS group scored lower than the S group regarding general and some specific psychopathology. The DDS patients ascribed reasons for substance use more often for hedonistic pursuit but also for reduction in symptoms and distress. There was a trend for alcohol to be used more for self‐medication purposes compared to opioids and cannabis. The perceived effects of these three substances were significantly different on several symptom / distress dimensions. Finally, there was some degree of “match” between symptom‐oriented reasons for use of substances and the effect that was perceived. All of this evidence provides a consistent but modest support for the SMH for “some patients, some substances, and some symptoms.” The implications are discussed. (Am J Addict 2004;13:139–150)