Skip to main content

The Self-Medication Hypothesis of Addictive Disorders: Focus on Heroin and Cocaine Dependence

  • Conference paper
The Cocaine Crisis

Abstract

The article which follows this introduction was originally published as a Special (Cover) Article in the American Journal of Psychiatry in the November, 1985 issue, the same month in which the First International Drug Symposium, sponsored by The Bahamas Ministry of Health and The Embassy of the United States of America, was convened to discuss the rock-cocaine epidemic in the Bahamas and other Caribbean Islands. Based on my article, I was invited to participate in the Symposium and to speak about some of my views on the psychological predispositions for drug dependence in general, and in particular, on the psychological predisposition for cocaine dependence. At first, I did not grasp the seriousness and scope of the cocaine problem, but I accepted the invitation, believing I might make a contribution to the Symposium. I was not long in attendance at the Symposium before I realized that the Bahamian citizens, professionals, and health care leaders were facing a major crisis as a consequence of the cocaine epidemic.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. E.J.Khantzian, Opiate addiction: a critique of theory and some implications for treatment, Am. J. Psychother., 28:59–70, (1974).

    PubMed  CAS  Google Scholar 

  2. E.J.Khantzian, C. Treece, Psychodynamics of drug dependence: an overview, in: “Psychodynamics of Drug Dependence: NIDA Research Monograph 12,,” J.D. Blaine, D.A. Julius, eds., National Institute on Drug Abuse, Rockville, Md.,(1977).

    Google Scholar 

  3. I. Chein, D.L.Gerard, R.S.Lee, et al.,“The Road to H: Narcotics, Delinquency, and Social Policy,,” Basic Books, New York, (1964).

    Google Scholar 

  4. D.L.Gerard, C. Kornetsky, Adolescent opiate addiction: a case study, Psychiatr. Q., 28:367–380, (1954).

    Article  PubMed  CAS  Google Scholar 

  5. D.L.Gerard, C. Kornetsky, Adolescent opiate addiction: a study of control and addict subjects, Psychiatr.Q., 29:457–486, (1955).

    Article  PubMed  CAS  Google Scholar 

  6. H. Wieder, E.H. Kaplan, Drug use in adolescents: psychodynamic meaning and phamacogenic effect, Pschoanal. Study Child, 24:399–431, (1969).

    CAS  Google Scholar 

  7. H. Milkman, W.A. Frosch, On the preferential abuse of heroin and amphetamine, J. Nerv. Ment. Dis., 156:242–248, (1973).

    Article  PubMed  CAS  Google Scholar 

  8. L. Wurmser, Methadone and the craving for narcotics: observations of patients on methadone maintenance in psychotherapy, in “Proceedings of the Fourth National Methadone Conference, San Francisco, 1972,,” National Association for the Prevention of Addiction to Narcotics, New York, (1972).

    Google Scholar 

  9. L. Wurmser, Psychoanalytic considerations of the etiology of compulsive drug use, J. Am. Psychoanal. Assoc., 22:820–843, (1974).

    Article  PubMed  CAS  Google Scholar 

  10. E. J. Khantzian, A preliminary dynamic formulation of the psychopharma-cologic action of methadone, in “Proceedings of the Fourth National Methadone Conference, San Francisco, 1972, National Association for the Prevention of Addiction to Narcotics,,” (1972).

    Google Scholar 

  11. E.J. Khantzian, An ego-self theory of substance dependence: a contemporary psychoanalytic perspective, in “Theories on Drug Abuse: NIDA Research Monograph 30,,” D.J. Lettieri, M. Sayers, H.W. Pearson, eds. National Institute on Drug Abuse, Rockville,Md., (1980).

    Google Scholar 

  12. E. J. Khantzian, Psychological (structural) vulnerabilities and the specific appeal of narcotics, Ann. N.Y. Acad. Sci., 398:24–32 (1982).

    Article  PubMed  CAS  Google Scholar 

  13. P. Radford, S. Wiseberg, C. Yorke, A study of “main line” heroin addiction, Psychoanal. Study. Child., 27:156–180 (1972).

    Google Scholar 

  14. H. Krystal, H. A. Raskin, “Drug Dependence: Aspects of Ego Functions,,” Wayne State University Press, Detroit (1970).

    Google Scholar 

  15. G. E. Woody, C. P. O’Brien, K. Rickels, Depression and anxiety in heroin addicts: a placebo-controlled study of doxepin in combination with methadone, Am. J. Psychiatry, 132:447–450 (1975).

    PubMed  CAS  Google Scholar 

  16. A. T. McLellan, G. E. Woody, C. P. O’Brien, Development of psychiatric illness in drug abusers, N. Engl. J. Med., 201:1310–1314 (1979).

    Article  Google Scholar 

  17. W. Dorus, E. C. Senay, Depression, demographic dimension, and drug abuse, Am. J. Psychiatry, 137:699–704 (1980).

    PubMed  CAS  Google Scholar 

  18. M. M. Weissman, F. Slobetz, B. Prusoff, et al., Clinical depression among narcotic addicts maintained on methadone in the community, Am. J. Psychiatry, 133:1434–1438 (1976).

    PubMed  CAS  Google Scholar 

  19. B. J. Rounsaville, M. M. Weissman, H. Kleber, et al., Heterogeneity of psychiatric diagnosis in treated opiate addicts, Arch. Gen. Psychiatry, 39:161–166 (1982).

    PubMed  CAS  Google Scholar 

  20. B. J. Rounsaville, M. M. Weissman, K. Crits-Cristoph, et al., Diagnosis and symptoms of depression in opiate addicts: course and relationship to treatment outcome, Arch. Gen. Psychiatry, 39:151–156 (1982).

    PubMed  CAS  Google Scholar 

  21. K. Vereby, ed., Opiods in Mental Illness: Theories, Clinical Observations, and Treatment Possibilities, Ann. N. Y. Acad. Sci., 398:1–512 (1982).

    Google Scholar 

  22. C. Treece, B. Nicholson, DSM-III personality type and dose levels in methadone maintenance patients, J. Nerv. Ment. Pis., 168:621–628 (1980).

    Article  CAS  Google Scholar 

  23. B. Nicholson, C. Treece, Object relations and differential treatment response to methadone maintenance, J. Nerv. Ment. Dis., 169:424–429 (1981).

    Article  PubMed  CAS  Google Scholar 

  24. E. J. Khantzian, C. Treece, PSM-III psychiatric diagnosis of narcotic addicts: recent findings, Arch. Gen. Psychiatry (in press).

    Google Scholar 

  25. S. J. Blatt, W. Berman, S. Bloom-Feshback, et al., Psychological assessment of psychopathology in opiate addicts, J. Nerv. Ment. Dis., 156–165 (1984).

    Google Scholar 

  26. B. J. Rounsaville, W. Glazer, C. H. Wilber, et al., Short-term interpersonal psychotherapy in methadone-maintained opiate addicts, Arch. Gen. Psychiatry, 40:629–636 (1983).

    PubMed  CAS  Google Scholar 

  27. G. E. Woody, L. Luborsky, A. T. McLellan, et al, Psychotherapy for opiate addicts, Arch. Gen. Psychiatry, 40:639–645 (1983).

    PubMed  CAS  Google Scholar 

  28. A. T. Butterworth, Pepression associated with alcohol withdrawal: imipramine therapy compared with placebo, Q. J. Stud. Alcohol., 32:343–348 (1971).

    PubMed  CAS  Google Scholar 

  29. J. E. Overall, P. Brown, J. P. Williams, et al., Prug treatment of anxiety and depression in detoxified alcoholic patients, Arch. Gen. Psychiatry, 29:218–221 (1973).

    PubMed  CAS  Google Scholar 

  30. F. M. Quitkin, A. Rifkin, J. Kaplan, et al., Phobic anxiety syndrome complicated by drug dependence and addiction, Arch. Gen. Psychiatry, 27:159–162 (1972).

    PubMed  CAS  Google Scholar 

  31. F. H. Gawin, H. P. Kleber, Cocaine abuse treatment, Arch. Gen. Psychiatry, 41:903–908 (1984).

    PubMed  CAS  Google Scholar 

  32. E. J. Khantzian, Self-selection and progression in drug dependence, Psychiatry Digest, 10:19–22 (1975).

    Google Scholar 

  33. E. J. Khantzian, J. E. Mack, A. F. Schatzberg, Heroin use as an attempt to cope: clinical observations, Am. J. Psychiatry, 131:160–164 (1974).

    PubMed  CAS  Google Scholar 

  34. E. J. Khantzian, Impulse problems in addiction: cause and effect relationships, in “Working With the Impulsive Person,,” H. Wishnie, ed., Plenum, New York (1979).

    Google Scholar 

  35. J. V. Spotts, F. C. Shontz, “The Life Styles of Nine American Cocaine Users,,” National Institute on Prug Abuse, Washington, P.C. (1977).

    Google Scholar 

  36. E. J. Khantzian, F. Gawin, H. P. Kleber, et al., Methylphenidate treatment of cocaine dependence-a preliminary report, J. Substance Abuse Treatment, 1:107–112 (1984).

    Article  CAS  Google Scholar 

  37. E. J. Khantzian, N. J. Khantzian, Cocaine addiction: is there a psychological predisposition?, Psychiatric Annals, 14(10):753–759 (1984).

    Google Scholar 

  38. E. J. Khantzian, An extreme case of cocaine dependence and marked improvement with methylphenidate treatment, Am. J. Psychiatry, 140: 784–785 (1983).

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1987 Plenum Press, New York

About this paper

Cite this paper

Khantzian, E.J. (1987). The Self-Medication Hypothesis of Addictive Disorders: Focus on Heroin and Cocaine Dependence. In: Allen, D.F. (eds) The Cocaine Crisis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1837-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-1837-8_7

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9026-1

  • Online ISBN: 978-1-4613-1837-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics