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Besides their general calming and “normalizing” effect, opiates attenuate intense, rageful, and violent affect.

They counter the internally fragmenting and disorganizing effects of rage and the externally threatening and disruptive aspects of such effects on interpersonal relations.

There is an old basic psychodynamic assumption that every psychological problem represents a solution.

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That is, the operative changes from the relief of suffering to the control of suffering.The self-medication hypothesis (SMH) is derived from clinical work with patients who have substance use disorders (SUDs).There are two core aspects of the SMH, namely that substances of abuse relieve human psychological suffering in susceptible individuals and that there is a considerable degree of psychopharmacologic specificity in an individual’s preferred drug.Substances of abuse can relieve a wide range of painful feelings associated with psychiatric illness, thus making patients with a psychiatric disorder more susceptible to SUDs.Those patients who are dually diagnosed with psychiatric illness and SUDs become dependent on a particular class of drugs to relieve the painful affects that predominate with their psychiatric disorder.Although they are not good antidepressants, alcohol and related drugs create the illusion of relief because they temporarily soften the rigid defenses and ameliorate states of isolation and emptiness that predispose to depression.Stimulants act as augmentors for hypomanic, high-energy individuals as well as those with atypical bipolar disorder.Presumably, either the sedating or stimulating properties can be the basis of its appeal.Ned Hallowell, MD, an authority on ADHD, has indicated that marijuana is very appealing to patients with this condition (verbal communication).For example, an agitated or enraged person will experience cocaine as disorganizing and threatening.An important point here is that addictive drugs are not universally appealing.

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