Self-medication

Source: Wikipedia, the free encyclopedia.

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

over-the-counter drugs and dietary supplements, which are used to treat common health issues at home. These do not require a doctor's prescription to obtain and, in some countries, are available in supermarkets and convenience stores.[1]

The field of

study drugs" such as Adderall, Ritalin, and Concerta has been widely reported and discussed in literature.[5]

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,

human right, implicit in, or closely related to the right to refuse professional medical treatment.[10] Self-medication can cause unintentional self-harm.[11] Self-medication with antibiotics has been identified as one of the primary reasons for the evolution of antimicrobial resistance.[12]

Sometimes self-medication or DIY medicine occurs because patients disagree with a doctor's interpretation of their condition,

anarchist beliefs.[19]

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

defense mechanisms.[22] According to Khantzian,[27]
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.[25] 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.[25][30]

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

Depression is often self-medicated by the use of alcohol, tobacco, cannabis, or other mind-altering drugs.[34] 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,[35]
and may lead to addiction or physical dependency, among other side effects of long-term use of the drug. This does not differ significantly from the potential effects of drugs provided by physicians, which are equally capable of producing dependency and/or addiction and also have side effects arising from long-term use.

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

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.[22][23] 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.[23][29] Most patients that have been hospitalized for substance use or alcohol dependence reported using drugs in response to depressive symptoms. This type of misuse is more likely in men than in women. This makes diagnosing a psychiatric disorder very difficult in substance abusers, because of self medicating.[37] People with social anxiety disorder commonly use these drugs to overcome their highly set inhibitions.[38]

Psychostimulants

amphetamines, methylphenidate, caffeine, and nicotine, produce improvements in physical and mental functioning, including increased energy and alertness. Stimulants tend to be most widely used by people with attention deficit hyperactivity disorder (ADHD), which can either be diagnosed or undiagnosed. Because a significant portion of people with ADHD have not been diagnosed they are more prone to using stimulants like caffeine, nicotine or pseudoephedrine to mitigate their symptoms. Unawareness concerning the effects of illicit substances such as cocaine, methamphetamine or mephedrone can result in self-medication with these drugs by individuals affected with ADHD symptoms. This self medication can effectively prevent them from getting diagnosed with ADHD and receiving treatment with stimulants like methylphenidate and amphetamines
.

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

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.[27][29] 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.[23][39][40]

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.[

N-acetylcysteine have been proposed for the treatment of addiction to cocaine, nicotine, and alcohol.[56]

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

developing countries.[58] Many people resort to that out of necessity when access to a physician is unavailable because of lockdowns and GP surgery closures, or when the patients have a limited amount of time or money to see a prescribing doctor. [59] While being cited as an important alternative to a formal healthcare system where it may be lacking, self-medication can pose a risk to both the patient and community as a whole. The reasons behind self-medication are unique to each region and can relate to health system, societal, economic, health factors, gender, and age. Risks include allergies, lack of cure, and even death.[60]

Besides developing countries, self-medication with

antibiotics is also a problem for higher-income countries. In the European Union the average prevalence was 7% in 2016 with the highest rates in southern countries. There are high rates of self-medication with antibiotics in Russia (83%), Central America (19%) and Latin America (14-26%) too.[61]

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

outbreaks can lead to death, e.g. due to haemorrhagic duodenitis induced by ibuprofen, or the consequences of exceeding the recommended doses of paracetamol by combining doses of the generic product with proprietary flu-remedies and Tylex (paracetamol and codeine).[65]

In a questionnaire designed to evaluate self-medication rates amongst the population of

antimalarials, 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%.[21] 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".[21]

Similarly, in a survey of university students in

southern China, 47.8% of respondents reported self-medicating with antibiotics.[66]

Other uses

One area of DIY medicine is self-administered pharmaceutical drugs that are obtained without a prescription, as in the case of

male pattern baldness, and obesity are often purchased online by people who have no diagnosis or prescription.[68][69] In 2017, the United Kingdom legalized the sale of sildenafil (Viagra) over the counter in part to cut down on the number of men buying it online from unlicensed pharmacies.[70]

Self-managed abortion with medication is safe and effective, but is illegal in some jurisdictions.[71][72] Before the current medication had been developed and in places where abortion is illegal, people may resort to unsafe methods of self-managed abortion.[73][74]

Another area is the creation of

fecal transplant as a treatment for various diseases.[82]

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

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.[85]

Regulation

Self-medication is highly regulated in much of the world and many

prohibition
.

People trying to buy pharmaceutical drugs online without a prescription may be the victim of

Z-drugs online without a prescription.[88]

See also

References

  1. ^ "What is self-Medication?". World Self-Medication Industry. Archived from the original on Jun 5, 2016. Retrieved 25 May 2016.
  2. ^ Kirstin Murray (2010-11-10). "Distressed doctors pushed to the limit". The 7.30 Report. Australian Broadcasting Corporation. Archived from the original on Apr 6, 2011. Retrieved 27 March 2011.
  3. ^ Vivek Benegal (October 12, 2010). "Addicted to alcohol? Here's why". India Today. Archived from the original on Jan 20, 2011. Retrieved 27 March 2011.
  4. ^ Howard Altman (October 10, 2010). "Military suicide rates surge". Tampa Bay Online. Archived from the original on 12 December 2010. Retrieved 27 March 2011.
  5. ^
    PMID 28985738
    .
  6. ^ .
  7. ^ .
  8. ^ Reese, Spencer M. "Dietary Supplement Marketing - Rethinking the Use of Third Party Material | MLM Law". www.mlmlaw.com. MLM Law Resources site. Retrieved 14 October 2018.
  9. ^ Benefits and risks of self-medication
  10. ^ Three arguments against prescription requirements, Jessica Flanigan, BMJ Group Journal of Medical Ethics 26 July 2012, accessed 20 August 2013
  11. PMID 24783837
    .
  12. ^ .
  13. .
  14. .
  15. ^ "This Drug Could Be the Next Ozempic. Bootlegs Are Already Selling Online". Wall Street Journal. 20 October 2023. Retrieved 15 December 2023.
  16. ^ "Barriers to trans care lead some to embrace a do-it-yourself approach". NBC News. 5 July 2023. Retrieved 15 December 2023.
  17. PMID 37305376
    .
  18. ^ "Can DIY Medicine Tame Rampaging Healthcare Costs?". The Rheumatologist. Retrieved 15 December 2023.
  19. ^ Oberhaus, Daniel (26 July 2018). "Meet the Anarchists Making Their Own Medicine". Vice. Retrieved 15 December 2023.
  20. ^ 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 (2000), "Guidelines for the Regulatory Assessment of Medicinal Products for use in Self-Medication" (PDF), WHO/EDM/QSM/00.1, Geneva: World Health Organization, retrieved 2012-09-02
  21. ^
    PMID 16124943
    . Retrieved 2012-09-02.
  22. ^ .
  23. ^ a b c d e f g h Khantzian E.J. (2003). "The self-medication hypothesis revisited: The dually diagnosed patient". Primary Psychiatry. 10: 47–48, 53–54.
  24. ^ a b Khantzian, E.J., Mack, J.F., & Schatzberg, A.F. (1974). Heroin use as an attempt to cope: Clinical observations. American Journal of Psychiatry, 131, 160-164.
  25. ^ a b c d Duncan D.F. (1974a). "Reinforcement of drug abuse: Implications for prevention". Clinical Toxicology Bulletin. 4: 69–75.
  26. ^ Duncan, D.F. (1974b). Letter: Drug abuse as a coping mechanism. American Journal of Psychiatry, 131, 174.
  27. ^ a b c d Khantzian, E.J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264.
  28. ^ a b c 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.
  29. ^ a b c Khantzian, E.J. (1999). Treating addiction as a human process. Northvale, NJ: Jason Aronson.
  30. .
  31. ^ 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
  32. ^ 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.
  33. doi:10.3109/14659890209169340.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  34. ^ Self-Medication With Alcohol and Drugs by Persons With Severe Mental Illness
  35. ^ Mental Illness: The Challenge Of Dual Diagnosis Archived 2009-03-08 at the Wayback Machine
  36. ^ Post Traumatic Stress Disorder
  37. PMID 1562010
    .
  38. ^ Sarah W. Book, M.D., and Carrie L. Randall, Ph.D. Social anxiety disorder and alcohol use. Alcohol Research and Health, 2002.
  39. PMID 23280888
    .
  40. – via PubMed.
  41. PMID 20438240.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  42. S2CID 210120636.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  43. .
  44. .
  45. .
  46. PMID 16725157.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  47. .
  48. S2CID 8755398.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  49. ^ Professor C Heather Ashton (1987). "Benzodiazepine Withdrawal: Outcome in 50 Patients". British Journal of Addiction. 82: 655–671.
  50. S2CID 19145509
    .
  51. .
  52. .
  53. .
  54. ^ .
  55. .
  56. .
  57. ^ "Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS)". amrcountryprogress.org. Retrieved 2023-03-28.
  58. S2CID 73434085
    .
  59. .
  60. .
  61. .
  62. .
  63. .
  64. .
  65. .
  66. .
  67. .
  68. .
  69. .
  70. ^ "Viagra can be sold over the counter". 28 November 2017. Retrieved 15 December 2023.
  71. PMID 37305376
    .
  72. .
  73. .
  74. .
  75. .
  76. ^ Oberhaus, Daniel (26 July 2018). "Meet the Anarchists Making Their Own Medicine". Vice. Retrieved 15 December 2023.
  77. PMID 31876179
    .
  78. .
  79. .
  80. .
  81. .
  82. .
  83. .
  84. ^ Nalini, G. K. (2010). "Self-Medication among Allopathic medical Doctors in Karnataka, India". British Journal of Medical Practitioners. 3 (2). Retrieved 2012-09-02.
  85. PMID 10798331
    .
  86. .
  87. .
  88. .

Further reading

External links