Reply to Self-Medication, Bipolar Disorders, and Stimulant Dependence

Letter to the Editor

Sir: We appreciate the opportunity to reply to the insightful
comments of Drs. Khantzian and Albanese regarding the selfmedication
hypothesis and our recent findings published in August
2008. We acknowledge that addiction etiology includes a
domain of psychologically distressing subjective factors such as
problems regulating self-esteem, relationships, and self-care, as
stated by Khantzian and Albanese.

Nejtek et al. used DSM-IV criteria for all subjects. Substance
"dependence" includes persistent psychological problems
and impaired social, occupational, and/or interpersonal functioning.
DSM-IV criteria for bipolar disorder suggest a level of severity
causing "marked impairment" evident in depressive and
manic symptoms such as psychomotor agitation, sleep disturbances,
excessive positive or negative self-worth, or irritability
creating an "unequivocal and uncharacteristic change in functioning
that is observed by others."