Self-medication

In general, self-medication is defined as "the use of drugs to treat self-diagnosed disorders or symptoms, intermittent or prolonged use of prescribed drugs for a chronic or recurring disease or symptoms."

Self-hypothesis

Since different drugs have different effects, they can be used for various reasons. According to the hypothesis of self-medication (HS), a person’s personal choice of certain drugs is not a case or coincidence, instead, it is the result of a personal psychological state, as selected drugs facilitate this condition. In particular, it is suggested that dependence acts as a compensatory means of modulating the influence and treatment of stressful conditions, where a person chooses medications that act best on a specific type of mental stress and help achieve emotional stability ^{[2] [3]} .

The self-medication hypothesis (GS) comes from the works of Edward Khantsyan, Mek and Schatzberg ^[4] , David F. Duncan ^[5] and the answers of Khantsyan to Duncan ^[6] . Initially, HS was focused on heroin use, but cocaine was also added in a subsequent paper ^[7] . Subsequently, GS extended to alcohol ^[8] , and in the end to all drugs that can cause addiction (drugs) ^[9] .

According to the views on Khantsyan’s addiction, drug consumers thus compensate for the shortcomings of their own ego by using them as a “solvent of the ego,” which acts on those parts of the personality that are cut off from consciousness by protective mechanisms . Hanqiang argued that drug addicts as a whole experience more mental stress than those who do not have such an addiction, and that the development of addiction involves the gradual attraction of the influence of drugs and the need to maintain this effect on the ego's protective construction activities. The choice of a specific medication by a dependent person is a consequence of the interaction of the psychopharmacological properties of the drug and the emotional states that she is trying to get rid of. The action of the drug replaces the defective or absent protective mechanisms of the ego. So, a person’s choice of specific substances is not accidental.

While Hanqiang takes a psychodynamic approach to self-medication, Duncan's model focuses on behavioral factors. Duncan described the nature of positive and negative encouragement and avoiding the symptoms of failure.

Specific Mechanisms

Some people who suffer from mental illness try to fix their illness with certain substances. Depression is often treated with alcohol , tobacco , cannabis and other means of altering consciousness ^[10] . Although this can bring immediate relief to certain symptoms, such as anxiety , such practices can also cause and / or aggravate the symptoms of several types of other available but latent mental illnesses ^[11] , and can lead to a predisposition / dependence, not to mention other possible side effects of prolonged use of the substance.

It is known that victims of post-traumatic stress disorder also resort to self-medication, as well as those who suffered from (mental) trauma, although they do not have the above diagnosis ^[12] .

CNS Depressants

Alcohol and sedatives / hypnotics , such as barbiturates and benzodiazepines , are depressants of the central nervous system (CNS), weaken the inhibitory mechanisms by anxiolysis. Depressants give rise to feelings of relaxation and drowsiness, while alleviating the symptoms of anxiety and depression. Although they, in general, are ineffective antidepressants, since most of them have a short-term effect, a sharp injection of alcohol and sedative / hypnotic substances can soften persistent protection and, in small / moderate doses, help to a certain extent get rid of depressive affect or anxiety. Because alcohol also loosens up internal restrictions, people who tend to hold back their emotions tend to drink it; in this case, alcohol gives them the opportunity to express a sense of affection, aggression or intimacy. People with social phobia often resort to these substances to overcome their own excessive internal restraint.

Psychostimulants

Psychostimulants such as cocaine , amphetamine, methylphenidate, caffeine and nicotine improve physical and mental functioning, including with increased energy and a sense of euphoria . Usually, people suffering from depression resort to stimulants in order to dull the anhedonia and increase self-esteem. HS also suggests that hyperactive and hypomanic individuals take stimulants to maintain their restless state and to increase euphoria. Stimulants are also beneficial for people who suffer from social anxiety by helping them break through their own internal limitations.

Opiates

Opiates like heroin and morphine act as analgesics , binding to opiate receptors in the brain and gastrointestinal tract . This weakens perception and response to pain and at the same time increases tolerance to pain. It is believed that opiates are used for self-medication from aggression and rage. They are an effective anxiolytic, mood stabilizer and antidepressant, however, people tend to treat anxiety and depression with depressants and stimulants, respectively, although this is by no means an absolute analysis.

Cannabis

Cannabis is paradoxical in its ability to create stimulating, sedative and moderately psychedelic and at the same time soothing or arousing properties, depending on the personality and conditions of use. Soothing properties are more visible to irregular consumers, while stimulants are more common among regulars. Khanqiang noted that the study was not sufficiently focused on the theoretical mechanism of cannabis, and therefore the latter was not added to the HS.

Efficiency

Long-term self-medication with benzodiazepines or alcohol often worsens the symptoms of anxiety or depression. It is believed that this is due to changes in brain chemistry due to prolonged use ^{[13] [14] [15] [16] [17]} . About half of people seeking help in psychiatric hospitals with anxiety disorders like panic disorder or social phobia have problems with alcohol or benzodiazepine addiction.

Sometimes anxiety arises primarily from alcohol or benzodiazepine addiction, but alcohol and benzodiazepines work to maintain anxiety disorders, often determining their deterioration. However, some people dependent on the latter, after explaining that they have a choice between a stably unsatisfied mental state and refusal to recover from symptoms, decide to give up alcohol and / or benzodiazepines. It is noted that each person has an individual level of sensitivity to alcohol or sedative hypnotic substances, and that one person can endure without impairment of health can lead to significant damage to the health of another person, and that even moderate drinking can lead to anxiety rebound syndrome and sleep disorders ^[18] .

Antibiotic self- treatment is common in some countries like Greece ^[19] . This phenomenon is a potential factor in the incidence of certain antibiotic-resistant bacterial infections in places like Nigeria ^[20] .

In a survey designed to assess the extent of self-medication in the state of Sudan Khartoum , 48.1% of respondents said that they had resorted to self-medication at least once in the previous 30 days, 43.4% were themselves treated with antimalarial drugs, and another 17.5% said they had both types of drugs. In general, the total distribution of self-medication with one or both types of anti-infective agents over the past 30 days was 73.9% ^[21] . Moreover, according to the data associated with the study, it was found that self-medication "varies significantly depending on socio-economic characteristics" and that "financial constraints were the main factor in self-medication."

Similarly, during a survey of students at a university in South China, 47.8% of respondents indicated that they resorted to self-medication with antibiotics ^[22] .

When studying students of medical schools in West Bengal and India, 57% of them reported that they resorted to self-medication. The most commonly used self-medication was antibiotics (31%), analgesics (23%), antipyretics (18%), antiulcer (9%), antitussive (8%), multivitamin (6%) and anthelmintic (4%) drugs ^{[ 23]} .

Another study found that 53% of doctors in Karnataka, India, reported self-medication with antibiotics.

A study of the Luo people in western Kenya revealed that 19% of them resorted to self-medication with either herbal or medicinal products. Compared to girls, boys were more likely to self-medicate with traditional medicine rather than herbs. One of the theories explains this phenomenon by the difference in potential incomes ^[24] .

In most countries of the world, self-medication is strictly regulated, and many types of medications are available exclusively on prescription provided by a medical professional. Security, social order , commercialization, and religion have historically been the dominant factors in such restrictions.

• Cognitive freedom
• Psychological trauma