He is the principal originator of the self-medication hypothesis (SMH) of drug abuse. Dr. Khantzian is a psychiatrist specializing in the study and treatment of addictive disorders. Trained as a psychoanalyst, early in his career he became interested in studying and treated addictions in the context of starting a methadone treatment program in 1970 at The Cambridge Hospital in Cambridge Massachusetts. Based on a modified psychodynamic perspective, his 1985 paper, The self-medication hypothesis of addictive disorders: focus on heroin and cocaine was published as a featured/cover article in the American Journal of Psychiatry. The SMH was updated in 1997 in the Harvard Review of Psychiatry emphasizing addiction as a self-regulation disorder wherein individuals self-medicate subjective states of psychological pain and suffering associated with individuals’ difficulties in regulating their emotions, self-esteem, relationships, and self-care (Khantzian 1995). In the 1997 Harvard Review article he applied the SMH to areas not previously considered involving nicotine dependence, schizophrenia, and post-traumatic stress disorder. The 1997 publication spelled out the main aspects of the SMH and the specific appeal of the main categories of addictive drugs. The two main aspects of the SMH are (1) drugs of abuse relieve psychological suffering and (2) there is a considerable degree of specificity in and individual’s drug-of-choice. Khantzian emphasized that in the context of individuals experimenting with different classes of drugs a person 'discovers' that a particular one becomes compelling because it ameliorates, heightens, or relieves feelings or states of distress that are especially problematic or painful for that individual. He described the main appeal of the various classes of addictive drugs as follow: • Opiates. 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 effects of such affects on interpersonal relations. • Central nervous system depressants (including alcohol). Alcohol’s appeal may reside in its properties as a “superego solvent. However, in my own experience, and based on observations by Krystal, short-acting depressants with rapid onset of action (e.g., alcohol, barbiturates, benzodiazepines) have their appeal because they are good “ego solvents.” That is, they act on those parts of the self that are cut off from self and others by rigid defenses that produce feelings of isolation and emptiness and related tense/anxious states and mask fears of closeness and dependency. Although they are not good antidepressants, alcohol and related drugs create the illusion of relief because they temporarily soften rigid defenses and ameliorate states of isolation and emptiness that predispose to depression. • Stimulants. Stimulants act as augmentors for hypomanic, high-energy individuals as well as persons with atypical bipolar disorder. They also appeal to people who are de-energized and bored, and to those who suffer from depression. In addition, stimulants, including cocaine, can act paradoxically to calm and counteract hyperactivity, emotional lability, and inattention in persons with attention-deficit/ hyperactivity disorder (Khantzian, 1983, 1985). Khantzian, 1997, pp. 232-233 References: Khantzian., E.J. (1985). The self-medication hypothesis of addictive disorders. American Journal of Psychiatry 142:1259-1264. Khantzian, E. J. (1995). Self-regulation vulnerabilities in substance abusers: Treatment implications. In S. Dowling (Ed.), The Psychology And Treatment Of Addictive Behavior. (pp. 17–41). New York: International Universities Press. Khantzian, E.J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4:231-244.
Khantzian is a first generation Armenian, born and raised in Haverhill, Massachusetts. When asked about his Armenian background, Khantzian said.
“My family origins were very important in my development. As a first generation Armenian my origins were humble and there were significant economic disadvantages and hardship, but our strong family identity and care, has played an important role in persisting with my goals to be a successful physician and a successful family man.” Born to a mother who lived through and survived the genocide, Khantzian is no stranger to adversity. His father died of a sudden heart attack when he was 16 years old, leaving him as the man of the house.
Dr. Khantzian began his college experience at Merrimack College (Evening Division) and is a graduate of Boston University and completed his medical education at Albany Medical College of Union University.
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