Rational self-medication

We develop a theory of rational self-medication. The idea is that forward-looking individuals, lacking access to better treatment options, attempt to manage the symptoms of mental and physical pain outside of formal medical care. They use substances that relieve symptoms in the short run but that may be harmful in the long run. For example, heavy drinking could alleviate current symptoms of depression but could also exacerbate future depression or lead to alcoholism. Rational self-medication suggests that, when presented with a safer, more effective treatment, individuals will substitute towards it. To investigate, we use forty years of longitudinal data from the Framingham Heart Study and leverage the exogenous introduction of selective serotonin reuptake inhibitors (SSRIs). We demonstrate an economically meaningful reduction in heavy alcohol consumption for men when SSRIs became available. Additionally, we show that addiction to alcohol inhibits substitution. Our results suggest a role for rational self-medication in understanding the origin of substance abuse. Furthermore, our work suggests that punitive policies targeting substance abuse may backfire, leading to substitution towards even more harmful substances to self-medicate. In contrast, policies promoting medical innovation that provide safer treatment options could obviate the need to self-medicate with dangerous or addictive substances.

That is a new NBER working paper by Michael E. Darden and Nicholas W. Papageorgge.

Comments

I offer the best Cleveland Steamer this side of the Allegheny!

In general alcoholics and other addicts do NOT self medicate for the reasons given, they do sometimes use that rationalization as an excuse, but the simple truth is they have addictive personalities and once addicted are unable to break that addiction without intervention.

People drink alcohol because it dulls psychic pain or because it enhances feelings of exuberance.

Yeah, right! That's as good as any excuse. So why start when they get up and continue all day until they pass out at night. Where's the exuberance in that? Everyone has drunk alcohol and know it's effects and it's downside. Almost everyone makes a decision to not drink to excess. Those who do not cannot help themselves, they did not make a decision to drink in excess they simply cannot stop. For most it is genetic, they are addicts, they literally cannot stop until they die or get some serious outside intervention. It is as simple as that. No complex social or legitimate issues it is addiction pure and simple.

Of course they can help themselves. Lots of people, myself included, make the choice stop drinking alcohol. And most alcoholics, even serious, hardcore ones like Jean-Claude Juncker, don't drink all day.

Again, people drink alcohol because they are seeking to dull psychic pain or enhance exuberance. Alcohol works great for both.

'lacking access to better treatment options'

Welcome to America, the shining jewel of lacking access to better treatment options.

Really. Just ask the Bartley J. Madden Chair in Economics at the Mercatus Center.

SSRIs are antidepressants and there's no free lunch. "During long-term SSRI therapy, the most troubling adverse effects are sexual dysfunction, weight gain, and sleep disturbance."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/

I think SSRIs could be less nocive than the worst cases of alcoholism. But where's the line where SSRIs is more nocive than alcohol? If this boundary is not well defined......people may end paying more $ for the same level of "management of the symptoms of mental and physical pain" since alcohol is cheaper than SSRIs.

"since alcohol is cheaper than SSRIs"
Do insurance plans cover alcohol? I don't know that I disagree completely with the rest of your claim, but the vast majority of people I know who take SSRIs pay very little for them, much less than most people who drink, even modestly, do for Alcohol.

Quite apart from the drawbacks, it should be noted that alcohol is not a competitor to anything in treating these problems because it just does not work for this purpose - https://en.wikipedia.org/wiki/Self-medication#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"

(I note that the article abstract is concerned largely with the reactions of people who may well believe falsely that alcohol offers genuine respite, so I have no quarrel with the original abstract.)

Alcohol is actually a pretty good anxiolytic. Don't try it, it is highly addictive when abused like that, but take my word for it if you are tense and take a few drinks it'll help you unwind. I thought this was common knowledge.

Tobacco in cigarette form, too. And yes, don't try it. They destroy the cardiovascular system.

Debates about substance abuse are incredibly naive. People act as if the alcoholic is under a mind-control voodoo curse. She's not. She drinks because it's fun.

1 unit of alcohol per day is absolutely guaranteed to far worse than 1 unit of SSRI per day.

I'm actually stunned that you think that kind of question is even worth asking.

Alcohol is genuinely terrible for you, even in small amounts.

Chronic use is even worse, doubly so for binge drinking.

The trap people who self medicate mental illness with Alcohol fall into is that chronic Alcohol use increases symptoms of depression/anxiety symptoms.

Cancer, heart disease, liver damage, obesity, all-cause mortality, depression/mental illness, cognitive decline, domestic violence, death...

Small amounts of alcohol are not bad for people- I'm talking a glass of wine with dinner or a beer after work. However, "self-medicating" with alcohol generally involves serious and regular boozing, which is not a healthy habit

> Small amounts of alcohol are not bad for people- I'm talking a glass of wine with dinner or a beer after work.

Nope, still bad for you. Still causes cancer, still increases all-cause mortality.

Now, don't get me wrong, wine is tasty, and those risks are probably pretty small at a rate of one or two glasses of wine per week.

But even at one glass per day, 7 units per week, is going to be more than a casual mostly-harmless habit.

there is no safe amount of alcohol -- " The level of alcohol consumption that minimised harm across health outcomes was zero"
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext

Sorry, but I call BS on this.

NFL doesn't apply here, there are absolutely free lunches where subjective utilities and wellbeing are concerned. And generic SSRIs are (typically) ~$10 a month.

The good news: binge drinking among high schoolers is falling: https://qz.com/1498294/binge-drinking-among-us-high-schoolers-hit-a-record-low-in-2018/

Not sure how much you can read into that trend. Mental Illness (e.g. Depression) is on the rise, and there's no reason to think these individuals won't begin to abuse alcohol when they are of age. That trend lines up with a general explanation that high schoolers today are living in more controlled environments.

How can "rational self-medication" get off the ground when our Federal overlords irrationally plop all kinds of pharmaceuticals into their odiously stupid "prohibition schedules"? (irrespective of actual "science", arguably)

Marijuana is NO "Schedule I" substance, except for the idiots lingering at the DEA or at our illustrious DOJ. (Marijuana HAS therapeutic applications, you DEA and Congressional dolts.)

LSD, its therapeutic applications also beyond dispute, also plainly does not belong on the idiot Federal registry of "Schedule I" substances.

"Rational self-medication" has little prospects as long as irrational loons and stooges enforce their Puritan-era prohibitions. (How "rational" might abolition of the irrational DEA's prohibition schedules be? --of the DEA itself?)

Why, why it's almost as if people use drugs to feel better. No, that couldn't be it. I mean it's not as if the way people feel is in anyway correlated to their health.

On the other hand, the pinned tweet on C. Kirabo Jackson's twitter states:

My new @NBER working paper is out!
(1) Schools impacts on test scores and other key outcomes are mostly unrelated to each other.
(2) Parents choose schools that impact high-stakes tests, crime, dropout, and employment.

If schools are unrelated to outcomes, what difference would spending differences make?

Something tells me family involvement may be a confounding variable when it comes to spending. https://www.insidehighered.com/admissions/article/2018/10/22/act-scores-drop-only-asian-americans-saw-gains

In order for this to work, the medication needs to be available AND the people need to be willing to take it. Alcohol has no social stigma associated with it--it's considered normal for a man to have a drink in his home or at a bar. Taking medication for a psychological disorder still carries a heavy stigma, though. So even if this is true, it's going to be hard to implement any meaningful change.

Obvious alcohol abuse has some stigma. Ask a woman in your life if she knows a guy who drinks too much, and ask her what she thinks of him. I think women are probably more sensitive to this, but I could relate to you stories of problem drinkers.

How can you be stigmatized for privately taking an antidepressant? It's not like you have to tell everyone you're on mood-altering drugs.

The issue, as I see it, is that the cost to access Alcohol is very low, and the cost to gain access to antidepressants one needs (for example) is very high.

Anti-depressants keep the lows from getting too low--that's all. Alcohol is a lot more fun. The consequences of alcohol abuse aren't fun--far from it--but the drinking itself is a blast. Lots more fun than SSRIs.

Alcohol, on the other hand, is mostly a lot of fun.

P.S. I'm not drunk I just wish I was. The small combox is misleading on edits so I ended up leaving in that last sentence.

These two have almost stumbled onto an extremely obvious piece of common sense, but further research is necessary.

Agreed. This can be filed under: "No f*cking sh*t."

Yeah. Self-medication via intoxicants is a pretty old concept. One of the oldest, in fact.

Delete the FDA and the controlled substances act.

No rational, self interested person is going to take drugs that will harm them.

No rational, self interested pharmaceutical company is going to sell a drug they think will harm people.

There is an unprecedented liquidity of information. The argument that absent restrictions, people will be able to market and sell snake oil is (literally) from another time.

What does the FDA do?

Reduce the rate of creation of new pharmaceuticals.
Increase the cost of medicine.
Imposes barriers for people to access the medicine they need.
Generate rents for pharmaceutical companies.
Regularly approve and recommend harmful drugs.

No rational, self interested person is going to take drugs that will harm them.

No rational, self interested pharmaceutical company is going to sell a drug they think will harm people.

Yeah, I was a libertarian teenager once too.

Heroin, pornography, doughnuts, and tobacco all cause harm and everybody knows it. People still buy and sell them. You need a better argument.

Heroin addicts aren't acting in their own best interest, and they're still getting access to drugs with or without the FDA and Controlled Substances Act.

In other words, you're the one that needs an argument.

Let the heroin addicts kill themselves, I don't care, and neither do they. Are you going to stop building bridges because a few people who want to die jump off of them?

What the FDA is effective at is limiting access to medicine that people need, in particular when it's not a drug of abuse.

That's a different argument.

I'm not saying drugs should be criminalized. There are plenty of arguments that they shouldn't be, but not the one that no rational, self-interested person will buy or sell harmful products, because it's just not true.

So coffee still gets a clean call, as a self medication, especially for gentleman of a certain age?

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