View source for Self-medication

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:This article is about the self administration of drugs in humans. For the operant study of self reward in animals see: [[Self-administration]].

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'''Self-medication''' is a [[human behavior]] in which an individual uses unprescribed [[drug]]s to treat untreated and often undiagnosed medical ailments.

The [[psychology]] of such behavior within the specific context of using [[recreational drug]]s, [[psychoactive drug]]s, [[Ethanol|alcohol]], and other self-soothing forms of behavior to alleviate symptoms of [[mental distress]], [[Stress (biology)|stress]] and [[anxiety]],<ref>{{cite web | url=http://www.abc.net.au/7.30/content/2010/s3035410.htm| title=Distressed doctors pushed to the limit | author=Kirstin Murray | date=11/10/2010 | publisher=Australian Broadcasting Corporation | accessdate=27 March 2011 }}</ref> including [[mental disorder|mental illnesses]] and/or [[psychological trauma]],<ref>{{cite web | url=http://indiatoday.intoday.in/site/Story/116093/Lifestyle/addicted-to-alcohol-heres-why.html| title=Addicted to alcohol? Here's why | author=Dr Vivek Benegal | date=October 12, 2010  | publisher=India Today | accessdate=27 March 2011 }}</ref><ref>{{cite web | url=http://www2.tbo.com/content/2010/oct/10/na-military-suicide-rates-surge/| title=Military suicide rates surge | author=Howard Altman | date=October 10, 2010 | publisher=Tampa Bay Online | accessdate=27 March 2011 }}</ref> is particularly unique and can serve as a serious detriment to [[health|physical]] and [[mental health]] if motivated by [[addictive behavior|addictive mechanism]]s.

Self-medication is often seen as gaining personal independence from established medicine,<ref>[https://www.researchgate.net/publication/11620093_Benefits_and_risks_of_self_medication Benefits and risks of self medication]</ref> and it can be seen as a [[human right]], implicit in, or closely related to the right to refuse professional medical treatment<ref>[http://jme.bmj.com/content/38/10/579.full.pdf+html Three arguments against prescription requirements], Jessica Flanigan, [http://jme.bmj.com/ BMJ Group] Journal of Medical Ethics 26 July 2012, accessed 20 August 2013</ref>

==Definition==
Generally speaking, self-medication is defined as "the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms"<ref name='WHO/EDM/QSM/00.1'> {{citation | coauthors = D. Bowen, G. Kisuule, H. Ogasawara, Ch. J. P. Siregar, G. A. Williams, C. Hall, G. Lingam, S. Mann, J. A. Reinstein, M. Couper, J. Idänpään-Heikkilä, J. Yoshida | contribution = Guidelines for the Regulatory Assessment of Medicinal Products for use in Self-Medication | title = WHO/EDM/QSM/00.1 | publisher = [[World Health Organization]] | place = Geneva | year = 2000 | contribution-url = http://apps.who.int/medicinedocs/pdf/s2218e/s2218e.pdf | format = PDF | accessdate = 2012-09-02}}</ref><ref name='Awad 2005-08-12'/>

==Psychology and psychiatry==

===Self-medication hypothesis===
As different drugs have different effects, they may be used for different reasons. According to the self-medication hypothesis (SMH), the individuals' choice of a particular drug is not accidental or coincidental, but instead, a result of the individuals' psychological condition, as the drug of choice provides relief to the user specific to his or her condition. Specifically, [[Substance use disorder|addiction]] is hypothesized to function as a compensatory means to modulate effects and treat distressful psychological states, whereby individuals choose the drug that will most appropriately manage their specific type of psychiatric distress and help them achieve emotional stability.<ref name=Khantzian1997>Khantzian, E.J. (1997). The self-medication hypothesis of drug use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231-244.</ref><ref name=Khantzian2003>Khantzian, E.J.  (2003). The self-medication hypothesis revisited: The dually diagnosed patient. Primary Psychiatry, 10, 47-48, 53-54.</ref>

The self-medication hypothesis (SMH) originated in papers by [[Edward Khantzian]], Mack and Schatzberg,<ref name=Khantzian1974>Khantzian, E.J., Mack, J.F., & Schatzberg, A.F.  (1974). [http://ajp.psychiatryonline.org/cgi/content/abstract/131/2/160 Heroin use as an attempt to cope: Clinical observations.] American Journal of Psychiatry, 131, 160-164.</ref> [[David F. Duncan]],<ref name=Duncan1974a>Duncan, D.F. (1974a). Reinforcement of drug abuse: Implications for prevention. Clinical Toxicology Bulletin, 4, 69-75.</ref> and a response to Khantzian by Duncan.<ref name=Duncan1974b>Duncan, D.F. (1974b). [http://ajp.psychiatryonline.org/cgi/content/citation/131/6/724 Letter: Drug abuse as a coping mechanism.]  American Journal of Psychiatry, 131, 174.</ref> The SMH initially focused on [[heroin]] use, but a follow-up paper added [[cocaine]].<ref name=Khantzian1985>Khantzian, E.J. (1985). [http://ajp.psychiatryonline.org/cgi/content/abstract/142/11/1259 The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence.] American Journal of Psychiatry, 142, 1259-1264.</ref> The SMH was later expanded to include alcohol,<ref name=Khantzian1990>Khantzian, E.J., Halliday, K.S., & McAuliffe, W.E. (1990). Addiction and the vulnerable self: Modified dynamic group therapy for drug abusers. New York: Guilford Press.</ref> and finally all drugs of addiction.<ref name=Khantzian1997/><ref name=Khantzian1999 >Khantzian, E.J. (1999). Treating addiction as a human process. Northvale, NJ: Jason Aronson.</ref>

According to Khantzian's view of addiction, drug users compensate for deficient ego function<ref name=Khantzian1974/> by using a drug as an "ego solvent", which acts on parts of the self that are cut off from consciousness by [[defense mechanism]]s.<ref name=Khantzian1997/> According to Khantzian,<ref name=Khantzian1985/> drug dependent individuals generally experience more psychiatric distress than non-drug dependent individuals, and the development of drug dependence involves the gradual incorporation of the drug effects and the need to sustain these effects into the defensive structure-building activity of the ego itself. The addict's choice of drug is a result of the interaction between the psychopharmacologic properties of the drug and the affective states from which the addict was seeking relief. The drug's effects substitute for defective or non-existent ego mechanisms of defense. The addict's drug of choice, therefore, is not random.

While Khantzian takes a psychodynamic approach to self-medication, Duncan's model focuses on behavioral factors. Duncan described the nature of positive reinforcement (e.g., the "high feeling", approval from peers), negative reinforcement (e.g. reduction of negative affect) and avoidance of withdrawal symptoms, all of which are seen in those who develop problematic drug use, but are not all found in all recreational drug users.<ref name=Duncan1974a/> While earlier behavioral formulations of drug dependence using operant conditioning maintained that positive and negative reinforcement were necessary for drug dependence, Duncan maintained that drug dependence was not maintained by positive reinforcement, but rather by negative reinforcement. Duncan applied a public health model to drug dependence, where the agent (the drug of choice) infects the host (the drug user) through a vector (e.g., peers), while the environment supports the disease process, through stressors and lack of support.<ref name=Duncan1974a/><ref name=Duncan1975>Duncan, D.F. (1975). The acquisition, maintenance and treatment of polydrug dependence: A public health model. Journal of Psychedelic Drugs, 7, 209-213. http://www.duncan-associates.com/PUBLICHEALTHMODEL.htm</ref>

Khantzian revisited the SMH, suggesting there is more evidence that psychiatric symptoms, rather than personality styles, lie at the heart of drug use disorders.<ref name= Khantzian1997/> Khantzian specified that the two crucial aspects of the SMH were that (1) drugs of abuse produce a relief from psychological suffering and (2) the individual's preference for a particular drug is based on its psychopharmacological properties.<ref name=Khantzian1997/> The individual's drug of choice is determined through experimentation, whereby the interaction of the main effects of the drug, the individual's inner psychological turmoil, and underlying personality traits identify the drug that produces the desired effects.<ref name=Khantzian1997/>

Meanwhile, Duncan's work focuses on the difference between recreational and problematic drug use.<ref name=Duncan1983>Duncan, D.F., & Gold, R.S. (1983). Cultivating drug use: A strategy for the 80s. Bulletin of the Society of Psychologists in Addictive Behaviors, 2, 143-147. http://www.addictioninfo.org/articles/263/1/Cultivating-Drug-Use/Page1.html</ref> Data obtained in the Epidemiologic Catchment Area Study demonstrated that only 20% of drug users ever experience an episode of drug abuse (Anthony & Helzer, 1991), while data obtained from the National Comorbidity Study demonstrated that only 15% of alcohol users and 15% of illicit drug users ever become dependent.<ref>Anthony, J., Warner, L., & Kessler, R. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances and inhalants: Basic findings from the National Comorbidity Study. Experimental and Clinical Psychopharmacology, 2, 244-268.</ref> A crucial determinant of whether a drug user develops drug abuse is the presence or absence of negative reinforcement, which is experienced by problematic users, but not by recreational users.<ref name=Nicholson>Nicholson, T., Duncan, D.F., & White, J.B. (2002). Is recreational drug use normal? Journal of Drug Use, 7, 116-123. http://www.duncan-associates.com/Is-Recreational-Drug-Use-Normal.pdf</ref> According to Duncan, drug dependence is an avoidance behavior, where an individual finds a drug that produces a temporary escape from a problem, and taking the drug is reinforced as an operant behavior.<ref name=Duncan1974a/>

===Specific mechanisms===
Some [[mental illness]] sufferers attempt to correct their illnesses by use of certain drugs. [[Clinical depression|Depression]] is often self-medicated with [[alcoholic beverage|alcohol]], [[tobacco]], [[cannabis]], or other mind-altering drug use.<ref>[http://jap.sagepub.com/cgi/content/abstract/5/3/80 Self-Medication With Alcohol and Drugs by Persons With Severe Mental Illness]</ref> While this may provide immediate relief of some symptoms such as anxiety, it may evoke and/or exacerbate some symptoms of several kinds of mental illnesses that are already latently present,<ref>[http://learn.genetics.utah.edu/content/addiction/issues/mentalillness.html Mental Illness: The Challenge Of Dual Diagnosis]</ref> and may lead to addiction/[[chemical dependency|dependence]], among other side effects of long-term use of the drug.

Sufferers of [[post-traumatic stress disorder]] have been known to self-medicate, as well as many individuals without this diagnosis who have suffered from (mental) trauma.<ref>[http://www.mnwelldir.org/docs/mental_health/ptsd.htm Post Traumatic Stress Disorder]</ref>

Due to the different effects of the different classes of drugs, the SMH postulates that the appeal of a specific class of drugs differs from person to person. In fact, some drugs may be aversive for individuals for whom the effects could worsen affective deficits.<ref name=Khantzian1997/>

====CNS depressants====
[[Ethanol|Alcohol]] and [[sedative]]/[[hypnotic]] drugs, such as [[barbiturates]] and [[benzodiazepines]], are [[central nervous system]] (CNS) [[depressants]] that lower inhibitions via [[anxiolysis]]. Depressants produce feelings of relaxation and sedation, while relieving feelings of depression and anxiety. Though they are generally ineffective antidepressants, as most are short-acting, the rapid onset of alcohol and sedative/hypnotics softens rigid defenses and, in low to moderate doses, provides relief from depressive affect and anxiety.<ref name=Khantzian1997/><ref name=Khantzian2003/> As alcohol also lowers inhibitions, alcohol is also hypothesized to be used by those who normally constrain emotions by attenuating intense emotions in high or obliterating doses, which allows them to express feelings of affection, aggression and closeness.<ref name=Khantzian2003/><ref name=Khantzian1999/> People with [[social anxiety disorder]] commonly use these drugs to overcome their highly set inhibitions.<ref>Sarah W. Book, M.D., and Carrie L. Randall, Ph.D. [http://pubs.niaaa.nih.gov/publications/arh26-2/130-135.htm Social anxiety disorder and alcohol use]. Alcohol Research and Health, 2002.</ref>

====Psychostimulants====
[[Psychostimulants]], such as [[cocaine]], [[amphetamines]], [[methylphenidate]], [[caffeine]], and [[nicotine]], produce improvements in physical and mental functioning, including increased energy and feelings of euphoria. Stimulants tend to be used by individuals who experience depression, to reduce [[anhedonia]]<ref name=Khantzian2003/> and increase self-esteem.<ref name= Khantzian1990/> The SMH also hypothesizes that hyperactive and hypomanic individuals use stimulants to maintain their restlessness and heighten euphoria.<ref name=Khantzian2003/><ref name=Khantzian1985/><ref name=Khantzian1990/> Additionally, stimulants are useful to individuals with social anxiety by helping individuals break through their inhibitions.<ref name= Khantzian2003/>

====Opiates====
[[Opiates]], such as [[heroin]] and [[morphine]], function as an analgesic by binding to [[opioid]] receptors in the brain and gastrointestinal tract. This binding reduces the perception of and reaction to pain, while also increasing pain tolerance. Opiates are hypothesized to be used as self-medication for aggression and rage.<ref name=Khantzian1985/><ref name= Khantzian1999/> Opiates are effective anxiolytics, mood-stabilizers, and anti-depressants, however, people tend to self-medicate anxiety and depression with depressants and stimulants respectively, though this is by no means an absolute analysis.<ref name=Khantzian2003/>

====Cannabis====
[[Cannabis (drug)|Cannabis]] is paradoxical in that it simultaneously produces stimulating, sedating and mildly psychedelic properties and both [[anxiolytic]] or [[anxiogenic]] properties, depending on the individual and [[set and setting|circumstances of use]]. Depressant properties are more obvious in occasional users, and stimulating properties are more common in chronic users. Khantzian noted that research had not sufficiently addressed a theoretical mechanism for cannabis, and therefore did not include it in the SMH.<ref name=Khantzian2003/> Cannabis is commonly used to self-medicate individuals with [[attention deficit hyperactivity disorder]], which has shown to improve symptoms for individuals with ADHD in studies.<ref>Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. NIH Consensus Statement Online 1998 Nov 16-18; 16(2): 1-37. Accessed October 2011.</ref>

===Effectiveness===
Self medicating excessively for prolonged periods of time with benzodiazepines or alcohol often makes the symptoms of anxiety or depression worse. This is believed to occur as a result of the changes in brain chemistry from long-term use.<ref>{{cite journal |author=Professor C Heather Ashton |url=http://www.benzo.org.uk/ashbzoc.htm |year=1987 |title= Benzodiazepine Withdrawal: Outcome in 50 Patients |journal=British Journal of Addiction |volume=82 |pages=655–671}}</ref><ref>{{cite journal |author=Michelini S |coauthors=Cassano GB, Frare F, Perugi G |year=1996 |month=July |title=Long-term use of benzodiazepines: tolerance, dependence and clinical problems in anxiety and mood disorders |journal= Pharmacopsychiatry |volume=29 |issue=4 |pages=127–34 |pmid=8858711 |doi=10.1055/s-2007-979558}}</ref><ref>{{cite journal |author=Wetterling T |coauthors=Junghanns K |year=2000 |month=Dec |title=Psychopathology of alcoholics during withdrawal and early abstinence |journal=Eur Psychiatry |volume=15 |issue=8 |pages=483–8 |pmid=11175926 |doi=10.1016/S0924-9338(00)00519-8}}</ref><ref>{{cite journal |author=Cowley DS |date=Jan 1, 1992 |title=Alcohol abuse, substance abuse, and panic disorder |journal=Am J Med |volume=92 |issue=1A |pages=41S–8S |pmid=1346485 |doi=10.1016/0002-9343(92)90136-Y}}</ref><ref>{{cite journal |author=Cosci F |coauthors=Schruers KR, Abrams K, Griez EJ |year=2007 |month=Jun |title=Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship |journal=J Clin Psychiatry |volume=68 |issue=6 |pages=874–80 |pmid=17592911 |doi=10.4088/JCP.v68n0608}}</ref> Of those who seek help from mental health services for conditions including [[anxiety disorders]] such as [[panic disorder]] or [[social anxiety disorder|social phobia]], approximately half have alcohol or [[benzodiazepine dependence]] issues.<ref name=pmid7769598/>

Sometimes anxiety precedes alcohol or benzodiazepine dependence but the alcohol or benzodiazepine dependence acts to keep the anxiety disorders going, often progressively making them worse. However, some people addicted to alcohol or benzodiazepines, when it is explained to them that they have a choice between ongoing poor mental health or quitting and recovering from their symptoms, decide on quitting alcohol or benzodiazepines or both. It has been noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs, and what one person can tolerate without ill health, may cause another to suffer very ill health, and even moderate drinking can cause rebound anxiety syndrome and sleep disorders. A person suffering the toxic effects of alcohol will not benefit from other therapies or medications, as these do not address the root cause of the symptoms.<ref name=pmid7769598>{{cite journal |author=Cohen SI |title=Alcohol and benzodiazepines generate anxiety, panic and phobias |journal=J R Soc Med |volume=88 |issue=2 |pages=73–7 |year= 1995 |month=February |pmid=7769598 |pmc=1295099 }}</ref>

==Infectious disease==
Self-medication with [[antibiotic]]s is commonplace in some countries, such as [[Greece]].<ref name='Skliros 2010-08-08'>{{cite journal | title = Self-medication with antibiotics in rural population in Greece: a cross-sectional multicenter study | journal = BMC Family Practice | date = 2010-08-08 | first = Eystathios | last = Skliros | coauthors = Panagiotis Merkouris, Athanasia Papazafiropoulou, Aristofanis Gikas, George Matzouranis, Christos Papafragos, Ioannis Tsakanikas, Irene Zarbala, Alexios Vasibosis, Petroula Stamataki, Alexios Sotiropoulos | volume = 11 | issue = 58 | doi = 10.1186/1471-2296-11-58 | url = http://www.biomedcentral.com/1471-2296/11/58 | accessdate = 2012-09-02}}</ref> Such use is cited as a potential factor in the incidence of certain [[Antibiotic resistance|antibiotic resistant]] [[bacterial infection]]s in places like [[Nigeria]].<ref name='Sapkota 2010-10-15'>{{cite journal | title = Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study | journal = BMC Public Health | date = 2010-10-15 | first = Amy R. | last = Sapkota | coauthors = Morenike E. Coker, Rachel E. Rosenberg Goldstein, Nancy L. Atkinson, Shauna J. Sweet, Priscilla O. Sopeju, Modupe T. Ojo, Elizabeth Otivhia, Olayemi O. Ayepola, Olufunmiso O. Olajuyigbe, Laura Shireman, Paul S. Pottinger, Kayode K. Ojo | volume = 10 | issue = 610 | doi = 10.1186/1471-2458-10-610 | url = http://www.biomedcentral.com/1471-2458/10/610/ | accessdate = 2012-09-02}}</ref>

In a questionnaire designed to evaluate self-medication rates amongst the population of [[Khartoum (state)|Khartoum]], [[Sudan]], 48.1% of respondents reported self-medicating with antibiotics within the past 30 days, 43.4% reported self-medicating with [[antimalarial]]s, and 17.5% reported self-medicating with both. Overall, the total prevalence of reported self-medication with one or both classes of anti-infective agents within the past month was 73.9%.<ref name='Awad 2005-08-12'>{{cite journal | title = Self-medication with antibiotics and antimalarials in the community of Khartoum State, Sudan. | journal = Journal of Pharmacy & Pharmaceutical Sciences | date = 2005-08-12 | first = Abdelmoneim | last = Awad | coauthors = Idris Eltayeb, Lloyd Matowe, Lukman Thalib | volume = 8 | issue = 2 | pages = 326–331 | id =  | url = http://www.ualberta.ca/~csps/JPPS8%282%29/A.Awad/sudan.htm | accessdate = 2012-09-02 | pmid=16124943}}</ref> Furthermore, according to the associated study, data indicated that self-medication "varies significantly with a number of socio-economic characteristics" and the "main reason that was indicated for the self-medication was financial constraints".<ref name='Awad 2005-08-12'/>

Similarly, in a survey of university students in [[Northern and southern China|Southern China]], 47.8% of respondents reported self-medicating with antibiotics.<ref name='Pan 2012-07-20'>{{cite journal | title = Prior Knowledge, Older Age, and Higher Allowance Are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China | journal = PLoS ONE | date = 2012-07-20 | first = Hui | last = Pan | editor-first = Richard | editor-last = Fielding | coauthors = Binglin Cui, Dangui Zhang, Jeremy Farrar, Frieda Law, William Ba-Thein | volume = 7 | issue = 7 | doi = 10.1371/journal.pone.0041314 | url = http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041314 | accessdate = 2012-09-02}}</ref>

==Physicians and medical students==
In a survey of [[West Bengal]], [[India]] [[undergraduate]] [[medical school]] students, 57% reported self-medicating. The type of drugs most frequently used for self-medication were antibiotics (31%), [[analgesic]]s (23%), [[antipyretic]]s (18%), antiulcerics (9%), [[cough suppressant]]s (8%), [[multivitamin]]s (6%), and [[anthelmintic]]s (4%).<ref name='Banerjee 2012 '>{{cite journal | title = Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal | journal = Journal of Postgraduate Medicine | date = 2012 April–June | first = I. | last = Banerjee | coauthors = T. Bhadury | volume = 58 | issue = 2 | pages = 127–131 | issn = 0972-2823 | pmid = 22718057 | doi = 10.4103/0022-3859.97175 | url = http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2012;volume=58;issue=2;spage=127;epage=131;aulast=Banerjee | accessdate = 2012-09-02}}</ref>

Another study indicated that 53% of [[allopathic medicine|allopathic physician]]s in [[Karnataka]], [[India]] reported self-administration of antibiotics.<ref name='Nalini 2010'>{{cite journal | title = Self-Medication among Allopathic medical Doctors in Karnataka, India | journal = British Journal of Medical Practitioners | year = 2010 | first = G. K. | last = Nalini | volume = 3 | issue = 2 | url = http://www.bjmp.org/content/self-medication-among-allopathic-medical-doctors-karnataka-india | accessdate = 2012-09-02}}</ref>

==Children==
A study of [[Luo people of Kenya and Tanzania|Luo]] children in western Kenya found that 19% reported engaging in self-treatment with either [[Traditional African medicine|herbal]] or [[Pharmaceutical drug|pharmaceutical]] medicine. Proportionally, boys were much more likely to self-medicate using conventional medicine than herbal medicine as compared with girls, a phenomenon which was theorized to be influenced by their relative earning potential.<ref name='Geissler 2000-06'>{{cite journal | title = Children and medicines: self-treatment of common illnesses among Luo school children in western Kenya | journal = Social Science & Medicine | date = June 2000 | first = P.W . | last = Geissler | coauthors = K. Nokes, R. J. Prince, R. Achieng Odhiambo, J. Aagaard-Hansen, J. H. Ouma | volume = 50 | issue = 12 | pages = 1771–1783 | id =  | doi = 10.1016/S0277-9536(99)00428-1 | accessdate = 2012-09-02 | pmid=10798331}}</ref>

==Regulation==
{{main|Regulation of therapeutic goods}}
Self-medication is highly regulated in much of the world and many [[Prescription drug|classes of drugs]] are available for administration only upon [[Medical prescription|prescription]] by licensed medical personnel. [[Pharmacovigilance|Safety]], [[social order]], [[commercialization]], and [[religion]] have historically been among the prevailing factors that lead to such [[Prohibition of drugs|prohibition]].

==Self medication with alcohol==

==Self medication and drugs of addiction==









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==See also==
* [[Biodiversity and drugs]]
* [[Comfort food]]
* [[Drug self administration]]
* [[Drug therapy]]
* [[Dual diagnosis]]
* [[Placebo effect]]
* [[Psychological trauma]]
* [[Zoopharmacognosy]]

==References & Bibliography== 
<references/>
==Key texts==          
===Books===
*Albanese, M. J., & Khantzian, E. J. (2002). Self-medication theory and modified dynamic group therapy. New York, NY: Haworth Press.
*Crawley, B. (1993). Self-medication and the elderly. Thousand Oaks, CA: Sage Publications, Inc.
*Harchik, A. E. (1994). Self-medication skills. Baltimore, MD: Paul H Brookes Publishing.
*Weiss, R. D., & Mirin, S. M. (1997). Substance abuse as an attempt at self-medication. New York, NY: New York University Press.

===Papers===
* Achalu, ED (2002).The self-medication hypothesis: a review of the two major theories and the research evidence. SMH: Recent Developments on the Self-Medication Hypothesis, 1(10), id1. [http://self-med-hypothesis.tripod.com/id1.html]
* Blenkinsopp A, Bradley C (1996). Over the counter drugs: the future for self medication. British Medical Journal, 312, 835.
* Duncan DF (1974a). Reinforcement of drug abuse: Implications for prevention. Clinical Toxicology Bulletin, 4(2), 69.
* Duncan DF (1974b). [http://ajp.psychiatryonline.org/cgi/content/citation/131/6/724 Drug abuse as a coping mechanism.] American Journal of Psychiatry, 131(6), 724. 
* Duncan DF (1975).The acquisition, maintenance and treatment of polydrug dependence: A public health model. Journal of Psychedelic Drugs, 7(2), 201.
* Hughes CM, McElnay JC, Fleming GF (2001). Benefits and risks of self medication. Drug Safety, 24, 1027
* Khantzian, EJ, Mack JE, Schatzberg AF (1974). [http://ajp.psychiatryonline.org/cgi/content/abstract/131/2/160 Heroin use as an attempt to cope: clinical observations.] American Journal of Psychiatry, 131(2), 160.
* Khantzian EJ (1985). [http://ajp.psychiatryonline.org/cgi/content/abstract/142/11/1259 The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence.] American Journal of Psychiatry, 142(11), 1259.
* Khantzian EJ (1990) Self-regulation and self-medication factors in alcoholism and the addictions. similarities and differences. Recent Developments in Alcoholism, 8, 255. 
*Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications: Harvard Review of Psychiatry Vol 4(5) Jan-Feb 1997, 231-244.
*Khantzian, E. J. (2003). The Self-Medication Hypothesis Revisited: The Dually Diagnosed Patient: Primary Psychiatry Vol 10(9) Sep 2003, 47-48, 53-54.
*Khantzian, E. J. (2003). Understanding Addictive Vulnerability: An Evolving Psychodynamic Perspective: Neuro-Psychoanalysis Vol 5(1) 2003, 5-21.
*Khantzian, E. J. (2003). "Understanding Addictive Vulnerability: An Evolving Psychodynamic Perspective": Response to Commentaries: Neuro-Psychoanalysis Vol 5(1) 2003, 53-56.
* Wazaify M, Shields E, Hughes CM, McElnay JC (2005). [http://fampra.oxfordjournals.org/cgi/content/full/22/2/170 Societal perspectives on over-the-counter (OTC) medicines.] Family Practice, 22: 170-176.

==Additional material==
===Books===
*Blazer, D. G. (2004). Alcohol and Drug Problems. Arlington, VA: American Psychiatric Publishing, Inc.
*Cheney, C. D. (1996). Medical nonadherence: A behavior analysis. New York, NY: Plenum Press.
*Huffman, M. A., & Wrangham, R. W. (1994). Diversity of medicinal plant use by chimpanzees in the wild. Cambridge, MA: Harvard University Press.
*Rand, C. S., & Weeks, K. (1998). Measuring adherence with medication regimens in clinical care and research. New York, NY: Springer Publishing Co.

===Papers===
*[http://scholar.google.com/scholar?sourceid=mozclient&num=50&scoring=d&ie=utf-8&oe=utf-8&q=Self-medication Google Scholar]

*Adu-Sarkodie, Y. A. (1997). Antimicrobial self medication in patients attending a sexually transmitted diseases clinic: International Journal of STD & AIDS Vol 8(7) Jul 1997, 456-458.
*Aguilar, M. C., Gurpegui, M., Diaz, F. J., & De Leon, J. (2005). Nicotine dependence and symptoms in schizophrenia: Naturalistic study of complex interactions: British Journal of Psychiatry Vol 186(3) Mar 2005, 215-221.
*Aharonovich, E., Nguyen, H. T., & Nunes, E. V. (2001). Anger and depressive states among treatment-seeking drug abusers: Testing the psychopharmacological specificity hypothesis: The American Journal on Addictions Vol 10(4) Fal 2001, 327-334.
*Alao, A. O., Westmoreland, N., & Jindal, S. (2003). Drug addiction in sickle cell disease: Case report: International Journal of Psychiatry in Medicine Vol 33(1) 2003, 97-101.
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===Dissertations==
*Adcock, S. A. W. (1993). The development and evaluation of an educational intervention to teach responsible medication use to senior adults: Dissertation Abstracts International.
*Alexander, G. L. (1992). Social support, self-esteem, and medication-taking behavior in older adults: Dissertation Abstracts International.
*Branin, J. J. (2003). Correlates of strategy use in medication adherence among older adults. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Caffery, D. M. (2007). Components of medication management: Psychometric properties of the Cognitive Screen for Medication Self-Management (CSMS) test in older adults. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Charupatanapong, N. (1990). An analysis of consumers' risk perceptions of their self-medication practices in Thailand: Dissertation Abstracts International.
*Damphousse, K. R. (1995). Reciprocal relationships between adolescent drug use and psychological distress: An examination of the self-medication hypothesis. Dissertation Abstracts International Section A: Humanities and Social Sciences.
*Dowell, M. S. (1991). People's expectations of their medications: An ethnographic study: Dissertation Abstracts International.
*Hall, D. H. (2005). Contributing to self-medication hypothesis research: A focus on severity of substance abuse and negative affect states in a methadone maintenance population. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Lynch, W. J. (2000). Regulation of intravenously self-administered drug intake in rats: Factors affecting, mechanisms underlying, and sex differences. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Miller, N. G. (1991). Decreasing medication abuse in psychiatric outpatients using special packaging: Dissertation Abstracts International.
*Miralles, M. A. (1993). Access to care and medication use among the ambulatory elderly in Rio de Janeiro, Brazil: Dissertation Abstracts International.
*Ostrowsky, M. K. (2007). Extending khantzian's self-medication hypothesis: An examination of low self-esteem, depression, alcohol use, marijuana use, and violent behavior. Dissertation Abstracts International Section A: Humanities and Social Sciences.
*Pabon, T. M. (2004). The self-medication theory of addictive disorders: Motivational aspects of drug addiction. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Rice, M. A. (1998). Concordant and discordant drug use in intimate relationships: A longitudinal study. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Robinson, R. J. (2008). Comorbidity of alcohol abuse and depression: Exploring the self-medication hypothesis. Dissertation Abstracts International: Section B: The Sciences and Engineering.
*Stawar, T. L. (1991). Perceptual learning style, modality-specific mnemonic elaboration strategies and achievement of severely psychiatrically disabled adults in self-medication management skills training: Dissertation Abstracts International.
*Stockwell, L. M. (1993). A qualitative exploration of medication-taking behaviors in the elderly: Dissertation Abstracts International.


=== External links ===
* [http://self-med-hypothesis.tripod.com Self-Medication Hypothesis informational website.]

[[Category:Addiction]]
[[Category:Alcohol abuse]]
[[Category:Drug self administration]]
[[Category:Coping]]
[[Category:Drug addiction]]
[[Category:Drug therapy]]
[[Category:Pharmacy]]
[[Category:Substance-related disorders]]


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