Darke 1 argues that the time is right for a reappraisal of opiate dependence as a consequence of self-medication. Although this suggestion has some good points, I find it hard to agree with the general outline of his argumentation. The idea of self-medication is—in Darke's version—built on two inter-related pillars. The first concerns the presence of a psychopathology that precedes the use of opiates, and the second is that the drug of choice is able to reduce the symptoms that follow with the psychopathology. While Darke provides a large number of references that support his claim for a significant association between psychopathology and social disadvantage, on one hand, and opiate dependence on the other hand, he does not really discuss the fact that many of these studies are based on highly selected clinical samples which do not illuminate the temporal ordering between the onset of psychopathology and opiate dependence. The work by Martins et al. 2 is put forward by Darke as a longitudinal study: ‘that indicates that pre-existing psychopathology and distress increases the risk for heroin use’. This is not, in my opinion, a reasonable thorough description of that study. In the first place, it is somewhat misleading to characterize the study as ‘longitudinal’, as its design is cross-sectional and relies upon retrospective reports. Secondly, the study of Martins et al. also found strong associations between pre-existing opiate dependency and the onset of psychiatric disorders. Even if the magnitudes of these associations are slightly smaller than the ones supporting the self-medication perspective, they are nevertheless important for the interpretation of observations of high levels of comorbidity in clinical samples of opiate-dependent individuals. A major problem with Darke's suggestions is the lack of a wider, societal perspective concerning the observed characteristics of contemporary opiate dependency. That the prevalence of some psychiatric disorders is relatively frequent among opiate misusers can be seen as a result of the fact that today non-medical use of opiates is illegal, and represents a grave violation of societal norms. The non-medical use of opiates in contemporary western societies is, by and large, only possible for individuals who belong to marginalized networks. Such individuals tend to be disadvantaged in almost all respects (low income, poor physical and mental health, more criminality, more substance misuse). Historical studies of the use of opiates have shown convincingly (see e.g. 3) that under different circumstances, as in the United States at the end of the 19th century, the typical opiate misuser was quite different from today. There were almost no federal or state regulations concerning the distribution of opiates, which were regularly available through pharmacies and as a main ingredient in many popular ‘patent medicines’. These circumstances brought about an opiate misuser who, typically, was a middle-class, rural, middle-aged woman. Given that the self-medication hypothesis is built upon the idea of a strong connection between the neurobiological effects of the drug of choice and the specific symptomatology of the psychopathology, it is reasonable to argue that one would expect this mechanism, if it is correct, to also produce the same type of opiate misusers over time and in different cultural contexts. Although Darke affirms the rational component of the self-medication model, i.e. that the use of opiates can be seen as an attempt to ‘self-repair’, he still considers the model as a whole to be a form of disease model, as it is the symptoms and distress that follow with the psychopathology that engender the misuse. An alternative approach to the individual's attempts to ‘self-repair’ through the use of substances that does not involve the necessity of pathology has been proposed by Bateson 4. Bateson stipulates that the substance misuser has ‘a converse matching between the sobriety and the intoxication, such that the latter may be seen as an appropriate subjective correction for the former’ (4, p. 226). The advantage with Bateson's approach is that its validity is less vulnerable than the self-medication model for the influence of the historical and cultural context of any given substance misuse. The idea of converse matching can accommodate conceptually the existence of substance misusers who, when they are sober, are bored, shy, aesthenic or just nervous (i.e. non-pathological dispositions), as well as those suffering from actual psychiatric disorders. None.