Self-regulation and self-medication factors in alcoholism and the addictions. Similarities and differences.

Addicts and alcoholics suffer vulnerabilities and deficits in self-regulation. A principal manifestation of their self-regulation disturbances is evident in the way they attempt to self-medicate painful affect states and related psychiatric problems. Individuals select a particular drug based on its ability to relieve or augment emotions unique to an individual which they cannot achieve or maintain on their own. Addicts and alcoholics usually experiment with all classes of drugs, but discover that a particular drug suits them best. Usually, painful affect states interact with other problems in self-regulation involving self-esteem, relationships, self-care, and related characterological defenses, making it more likely that addicts will experiment with and find the action of a particular drug appealing or compelling. Stimulants have their appeal because their energizing properties relieve distress associated with depression, hypomania, and hyperactivity; opiates are compelling because they mute and contain disorganizing affects of rage and aggression; and sedative hypnotics, including alcohol, permit the experience of affection, aggression, and closeness in individuals who are otherwise cut off from their feelings and relationships.