Self-medication
Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or fatigue.
The substances most widely used in self-medication are
The field of
Products are marketed by manufacturers as useful for self-medication, sometimes on the basis of questionable evidence. Claims that nicotine has medicinal value have been used to market cigarettes as self-administered medicines. These claims have been criticized as inaccurate by independent researchers.[6][7] Unverified and unregulated third-party health claims are used to market dietary supplements.[8]
Self-medication is often seen as gaining personal independence from established medicine,
Sometimes self-medication or DIY medicine occurs because patients disagree with a doctor's interpretation of their condition,
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".[20][21]
Self-medication can be defined as the use of drugs to treat an illness or symptom when the user is not a medically qualified professional. The term is also used to include the use of drugs outside their license or off-label.
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, 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.[22][23]
The self-medication hypothesis (SMH) originated in papers by Edward Khantzian, Mack and Schatzberg,[24] David F. Duncan,[25] and a response to Khantzian by Duncan.[26] The SMH initially focused on heroin use, but a follow-up paper added cocaine.[27] The SMH was later expanded to include alcohol,[28] and finally all drugs of addiction.[22][29][5]
According to Khantzian's view of addiction, drug users compensate for deficient ego function 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
Khantzian revisited the SMH, suggesting there is more evidence that psychiatric symptoms, rather than personality styles, lie at the heart of drug use disorders.[22] 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.[22] 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.[22]
Meanwhile, Duncan's work focuses on the difference between recreational and problematic drug use.[31] 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.[32] 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.[33] 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.[25]
Specific mechanisms
Some people who have a
People with post-traumatic stress disorder have been known to self-medicate, as well as many individuals without this diagnosis who have experienced psychological trauma.[36]
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.[22]
CNS depressants
Psychostimulants
Stimulants also can be beneficial for individuals who experience depression, to reduce anhedonia[23] and increase self-esteem,[28] however in some cases depression may occur as a comorbid condition originating from the prolonged presence of negative symptoms of undiagnosed ADHD, which can impair executive functions, resulting in lack of motivation, focus and contentment with one's life, so stimulants may be useful for treating treatment-resistant depression, especially in individuals thought to have ADHD. The SMH also hypothesizes that hyperactive and hypomanic individuals use stimulants to maintain their restlessness and heighten euphoria.[23][27][28] Additionally, stimulants are useful to individuals with social anxiety by helping individuals break through their inhibitions.[23] Some reviews suggest that students use psychostimulants to self medicate for underlying conditions, such as ADHD, depression or anxiety.[5]
Opiates
Modern research into novel antidepressants targeting opioid receptors suggests that endogenous opioid dysregulation may play a role in medical conditions including anxiety disorders, clinical depression, and borderline personality disorder.[41][42][43] BPD is typically characterized by sensitivity to rejection, isolation, and perceived failure, all of which are forms of psychological pain.[44] As research suggests that psychological pain and physiological pain both share the same underlying mechanism, it is likely that under the self-medication hypothesis some or most recreational opioid users are attempting to alleviate psychological pain with opioids in the same way opioids are used to treat physiological pain.[45][46][47][48]
Cannabis
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 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.[23]
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.[49][50][51][52][53] Of those who seek help from mental health services for conditions including anxiety disorders such as panic disorder or social phobia, approximately half have alcohol or benzodiazepine dependence issues.[54]
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 experience very ill health, and even moderate drinking can cause rebound anxiety syndrome and sleep disorders. A person experiencing the toxic effects of alcohol will not benefit from other therapies or medications, as these do not address the root cause of the symptoms.[54]
Nicotine addiction seems to worsen mental health problems. Nicotine withdrawal depresses mood, increases anxiety and stress, and disrupts sleep. Although nicotine products temporarily relieve their nicotine withdrawal symptoms, an addiction causes stress and mood to be worse on average, due to mild withdrawal symptoms between hits. Nicotine addicts need the nicotine to temporarily feel normal.[7][55] Nicotine industry marketing has claimed that nicotine is both less harmful and therapeutic for people with mental illness, and is a form of self-medication. This claim has been criticised by independent researchers.[6]
Self medicating is a very common precursor to full addictions and the habitual use of any addictive drug has been demonstrated to greatly increase the risk of addiction to additional substances due to long-term neuronal changes.[
Infectious diseases
In 89% of countries, antibiotics can be prescribed only by a doctor and supplied only by a pharmacy.[57] Self-medication with antibiotics is defined as "the taking of medicines on one's own initiative or on another person's suggestion, who is not a certified medical professional". It has been identified as one of the primary reasons for the evolution of antimicrobial resistance.[12]
Self-medication with antibiotics is an unsuitable way of using them but a common practice in
Besides developing countries, self-medication with
Two significant issues with self-medication are the lack of knowledge of the public on, firstly, the dangerous effects of certain antimicrobials (for example, ciprofloxacin, which can cause tendonitis, tendon rupture and aortic dissection)[62][63] and, secondly, broad microbial resistance and when to seek medical care if the infection is not clearing.[64]
Also inappropriate use of over-the-counter
In a questionnaire designed to evaluate self-medication rates amongst the population of
Similarly, in a survey of university students in
Other uses
One area of DIY medicine is self-administered pharmaceutical drugs that are obtained without a prescription, as in the case of
Another area is the creation of
Physicians and medical students
In a survey of
Another study indicated that 53% of physicians in Karnataka, India reported self-administration of antibiotics.[84]
Children
A study of
Regulation
Self-medication is highly regulated in much of the world and many
People trying to buy pharmaceutical drugs online without a prescription may be the victim of
See also
- Biodiversity and drugs
- Cognitive liberty
- Comfort food
- Dual diagnosis
- Alcoholism
- Emotional eating
- Psychedelic microdosing
- Psychological trauma
- Zoopharmacognosy
- Self-surgery
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Further reading
- Jain, Sonam; Reetesh Malvi; Jeetendra Kumar Purviya (2011). "Concept of Self Medication: A Review" (PDF). International Journal of Pharmaceutical & Biological Archives. 2 (3): 831–836.