Self-medication Hypothesis Research Articles

M116 - SMOKING AND NEUROTICISM: USING MENDELIAN RANDOMIZATION TO INVESTIGATE CAUSALITY

Background Smoking is one of the leading modifiable risk factors for disability, disease and death. There is a well-documented association between smoking and neuroticism, with smokers reporting increased levels of neuroticism. However, much of this data comes from observational studies and we are unable to make any causal inference regarding this relationship. Methods Mendelian Randomization (MR) is a method of assessing causality using observational data through the use of genetic instrumental variables for modifiable risk factors. Recent GWAS have identified variants robustly associated with both smoking phenotypes and neuroticism. This enabled us to use a range of MR methods to attempt to unpick this relationship. We use publicly available summary statistics from these studies in addition to data from UK Biobank to investigate whether there appears to be a causal link between smoking and neuroticism. Results We found evidence of a modest genetic correlation between smoking initiation and neuroticism (rG=0.124, p=0.0078). However, we found no strong evidence of a causal relationship in either direction when using 2-sample MR or when looking at individual level data in UK Biobank. Within UK Biobank it was possible to stratify on smoking status, which meant that in addition to smoking initiation, we were able to look at the association between smoking heaviness and neuroticism. We found some evidence of a causal relationship from neuroticism to increased smoking heaviness (β=0.198, p=0.014). Discussion In conclusion, although much of the observed association between smoking and neuroticism appears to be non-causal, we found evidence of a modest genetic correlation, suggesting some shared genetic aetiology. We also found some evidence of a causal relationship from neuroticism to smoking heaviness, which would lend support to the self-medication hypothesis.

Preservation Effect: Cigarette Smoking Acts on the Dynamic of Influences Among Unifying Neuropsychiatric Triple Networks in Schizophrenia.

The high prevalence of cigarette smoking in schizophrenia (SZ) is generally explained by the self-medication theory. However, its neurobiological mechanism remains unclear. The impaired dynamic of influences among unifying neuropsychiatric triple networks in SZ, including the central executive network (CEN), the default mode network (DMN), and the salience network (SN), might explain the nature of their syndromes, whereas smoking could regulate the dynamics within networks. Therefore, this study examined whether cigarette smoking could elicit a distinct improvement in the dynamics of triple networks in SZ and associated with the alleviation of symptoms. Four groups were recruited, namely, SZ smoking (n = 22)/nonsmoking (n = 25), and healthy controls smoking (n = 22)/nonsmoking (n = 21). All participants underwent a resting-state functional magnetic resonance imaging (fMRI). The dynamics among unifying neuropsychiatric triple networks were measured using Granger causality analysis on the resting-sate fMRI signal. Interaction effects between SZ and smoking on dynamics were detected using 2-way analysis of covariance, correcting for sex, age, and education level. Whereas smoking reduced SN→DMN dynamic in healthy controls, it preserved the dynamic in SZ, thus suggesting a preservation effect. Moreover, smoking additionally increased DMN→CEN dynamic in SZ. This finding from neural pathways shed new insights into the prevailing self-medication hypothesis in SZ. More broadly, this study elaborates on the neurobiological dynamics that may assist in the treatment of the symptomatology of SZ.

Cognitive functions in smoking and non-smoking patients with schizophrenia: A systematic review and meta-analysis of comparative studies

The “Self-medication hypothesis” that has been developed to explain the effect of nicotine in improving aspects of cognitive impairment in schizophrenia remains controversial. This systematic review and meta-analysis compared cognitive functions between smoking and non-smoking schizophrenia patients. The PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library databases were systematically and independently searched. Basic demographic and clinical characteristics, smoking history and cognitive performance were recorded. Seven of the 11 studies included in the study, had meta-analyzable data. Compared to non-smoking schizophrenia patients, their smoking counterparts showed significant deficits on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)-immediate memory (n = 739), the RBANS-total score (n = 739) and the Continuous Performance Test-Identical Pairs (n = 157). Two of the 4 studies without meta-analysable data did not report significant group difference in performance on the Wechsler Digit Span Task and the Beck Cognitive Insight Scale, while the other 2 studies found that non-smokers outperformed than smokers in problem solving and visual learning. In conclusion, this systematic review and meta-analysis found that smoking schizophrenia patients had worse performance in certain cognitive tasks than non-smoking patients, casting doubts on the validity of the “self-medication hypothesis” that needs to be further examined.

Smoking, symptoms, and quality of life in patients with psychosis, siblings, and healthy controls: a prospective, longitudinal cohort study

The self-medication hypothesis postulates that the high prevalence of smoking in patients with psychosis can be explained by the ameliorating effect of smoking on symptoms. However, there are few large prospective studies testing this hypothesis. We aimed to examine the multi-cross-sectional and prospective associations of changes in smoking behaviour with symptoms and quality of life. In this prospective cohort study we recruited patients with a non-affective psychosis (n=1094), unaffected siblings (n=1047), and healthy controls (n=579). Patients aged between 16 and 50 years and diagnosed with a non-affective psychosis according to DSM-IV were recruited by clinicians from four university medical centres and 36 associated mental health-care institutions in the Netherlands and Belgium between Jan 13, 2004, and March 6, 2014. Smoking status and number of cigarettes per day were assessed at baseline, and at 3-year and 6-year follow-up using the Composite International Diagnostic Interview (CIDI). Symptom frequency was self-rated with the Community Assessment of Psychotic Experience (CAPE), and quality of life was assessed by the WHO Quality of Life (WHOQOL) schedule. Multiple linear mixed-effects regression analyses were done accounting for multiple confounders. At baseline, 729 (67%) of 1094 of patients smoked (mean 17·5 cigarettes per day, SD 8·8) compared with 401 (38%) of 1047 siblings and 145 (25%) of 579 healthy controls. Multi-cross-sectional results of linear mixed-effects analyses showed that smoking in patients and siblings was associated with more frequent positive symptoms (estimate 0·14, SE 0·02, p<0·0001 in patients; 0·03, 0·01, p=0·0019 in siblings), negative symptoms (0·15, 0·03, p<0·0001 in patients; 0·09, 0·02, p<0·0001 in siblings), and depressive symptoms (0·12, 0·03 p<0·0001 in patients; 0·08, 0·02 p<0·0001 in siblings) and lower quality of life (-0·59, 0·11, p<0·0001 in patients; -0·31, 0·09, p=0·0002 in siblings) than non-smokers. In controls, smoking was associated with significantly higher frequency of subclinical positive symptoms (0·03, 0·01, p=0·0016) and depressive symptoms (0·05, 0·03, p=0·0432) than in participants who did not smoke. Patients who started to smoke during follow-up showed a significant increase in self-reported symptoms, particularly positive symptoms (0·161, 0·077, p=0·0381), whereas smoking cessation was not associated with changes in symptoms or quality of life compared with those who showed no change in smoking behaviour. Similar results were obtained for the changes in the number of cigarettes smoked. Our findings do not empirically support the self-medication hypothesis. The absence of long-term symptomatic relief from smoking should encourage clinicians to help patients with psychosis to quit smoking. Dutch Health Research Council, Lundbeck, AstraZeneca, Eli Lilly, Janssen Cilag, Academic Psychiatric Center of the Academic Medical Center, GGZ inGeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Center Amsterdam, GGZ Noord Holland Noord, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht, Parnassia Psycho-medical Center, Maastricht University Medical Center, GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET GGZ, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem, University Medical Center Utrecht, Altrecht, GGZ Centraal, and Delta.

Nicotine in action: cigarette smoking modulated homotopic functional connectivity in schizophrenia.

Cigarette smoking is intimately associated with both early onset and increased severity of schizophrenia. The self-medication hypothesis suggests that nicotine can relieve or restore neurocognitive deficits and symptoms associated with schizophrenia. Schizophrenia patients and healthy subjects who smoked showed deficits in communication between their hemispheres. These homotopic connectivity mechanisms associated with both schizophrenia and smoking comorbidity were largely unknown until now. A mixed sample including patients with schizophrenia (22 smokers and 27 non-smokers) and healthy controls (22 smokers and 21 non-smokers) based on clinical diagnoses and cigarette dependence were recruited for the current study. All subjects underwent resting-state functional magnetic resonance imaging to determine possible interactions between schizophrenia and smoking, and to determine the main effects of schizophrenia and smoking on homotopic functional connectivity. Decreased homotopic functional connectivity of the subgenual anterior cingulate cortex suggested a main effect of schizophrenia and smoking-an additive effect. Furthermore, we found an antagonistic interaction effect between schizophrenia and smoking located in the ventrolateral prefrontal cortex (VLPFC). In addition, the connectivity strength of the bilateral VLPFC was negatively correlated with the Positive and Negative Syndrome Scale Negative scores and positively correlated with lifetime smoking. These results suggest that smoking has multiple effects on the modulation of interhemispheric connectivity in schizophrenia. Our findings provide valuable information underlying the pathophysiological mechanisms of schizophrenia and offer a potential target for future clinical treatment of schizophrenia and smoking comorbidity.

Self-medication Hypothesis and Family Socialization Theory: Examining Independent and Common Mechanisms Responsible for Binge Drinking.

For many, binge drinking behaviors start early and become a persistent pattern of use throughout the lifespan. In an effort to strengthen understanding of etiology, this study considered the mechanisms from the self-medication hypothesis and family socialization theory. The goal was to identify whether emotional distress is a potential shared mechanism that accounts for the development of binge drinking in different developmental periods. This study used the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset to examine binge drinking across time for n=9,421 participants ranging in age from 11 to 18 (M=15.39, SD=1.62) at Wave I and ranging from 24 to 32 (M=28.09, SD=1.61) at Wave IV of the study. Using an autoregressive cross-lagged model, I examined how parent-child closeness, depressive symptoms, and binge drinking were related over three developmental periods. In examining cross-sectional and longitudinal relations, depressive symptoms were significantly related to binge drinking more often than parent-child closeness; however, results indicated the self-medication model may primarily account for concurrent drinking behaviors rather than long-term. The family socialization theory was indicated to account for some variability above and beyond the self-medication hypothesis. No indirect association between binge drinking and the parent-child relationship was detected through depressive symptoms, failing to support a shared mechanism between the two theories. The results provide support for a multifaceted assessment process for substance using clients, and support the use of Multisystemic Family Therapy, Multidimensional Family Therapy, and perhaps Attachment-Based Family Therapy.

Addiction Lives: Ingeborg Rossow.

Addiction Lives: Ingeborg Rossow.

Traumatic Experiences in Childhood and Adult Substance Use in a Nonclinical Sample: The Mediating Role of Arousal/Reactivity.

The vast majority of adults in the United States experience at least one traumatic event during childhood. According to the self-medication hypothesis of substance use disorders, adult survivors of childhood trauma may cope with trauma-related symptoms via alcohol or drug use. The purpose of this study is to identify through which specific PTSD symptom clusters childhood trauma exposure are associated with adult substance use. Participants of this study (N=627) were not recruited based on substance use or traumatic exposure. Results of this study demonstrate that arousal/reactivity partially mediates the association between childhood trauma and current substance use. Implications for treatment include recommendations for trauma-informed approaches that aim to decrease arousal/reactivity and subsequently substance use.

Forgiveness and substance use problems among college students: Psychache, depressive symptoms, and hopelessness as mediators

ABSTRACTStudies on forgiveness and its relationship to substance abuse have consistently found salutary associations between the two, yet empirical investigation of variables that may serve as mediating factors in this relationship is in need of more attention. With recent models positing psychological distress as a key component of the forgiveness-substance abuse association, constructs such as psychache, depression, and hopelessness may be likely candidates as mediators of this relationship. As such, cross-sectional, self-report data from 577 undergraduate students was used to perform multiple mediation analyses on the relationship of three dimensions of forgiveness (i.e., of self, of others, of uncontrollable situations) with two substance use outcomes (i.e., problematic alcohol use and problematic drug use), as mediated by psychache, depressive symptoms, and hopelessness. Results indicated that forgiveness of self and forgiveness of uncontrollable situations were associated with lower levels of psychological distress and fewer substance use problems, whereas forgiveness of others was associated with greater levels of psychological distress and more substance use problems. Psychache and depressive symptoms, but not hopelessness, played a role in the forgiveness–substance use problems association. Implications of these findings are discussed, particularly in the context of the self-medication hypothesis.

Alcohol Use and Depressive Symptoms Among a Nationally Representative Sample of Youth Investigated for Maltreatment

The relationships between depressive symptoms and alcohol use among maltreated youth have been well documented. However, the direction of these associations remains unclear. Two prevalent but contrasting perspectives on these associations-the self-medication and impaired-functioning hypotheses-have each received extensive support. The present study aims to test these hypotheses and to reconcile these theoretical and empirical inconsistencies by advancing a third integrative conceptualization, the bidirectional hypothesis, which considers developmental timing in the transactional associations between maltreated youth's depressive symptoms and alcohol use over time. Data were drawn from the National Survey of Child and Adolescent Well-Being II, a longitudinal, nationally representative sample of youth involved with Child Protective Services because they have been maltreated. The current study included data from 657 youth followed over three equidistant time points for 3 years. Youth were aged 11-14 years at the first time point, with 52.7% female and 51.4% White. Autoregressive analyses within a structural equation modeling framework supported the impaired-functioning hypothesis during early adolescence and the self-medication hypothesis during mid- to late adolescence. The data were consistent with the bidirectional hypothesis in which depressive symptoms and alcohol use differentially predicted each other depending on the stage of adolescence. The bidirectional associations between alcohol use and depressive symptoms are influenced by developmental timing. Researchers should consider age when tailoring prevention programs that target maltreated youth. Depressive symptoms should be screened early and frequently to prevent adolescent substance use.

Longitudinal prospective associations between psychological symptoms and heavy episodic drinking from adolescence to midlife.

This study examined whether development of psychological symptoms (PS) differed between persons with different longitudinal profiles of heavy episodic drinking (HED) from adolescence to midlife. In addition, the reciprocal associations between PS and HED were studied. Participants of a Finnish cohort study in 1983 at age 16 ( N = 2194) were followed up at ages 22 ( N = 1656), 32 ( N = 1471), and 42 ( N = 1334). HED was assessed with frequency of intoxication (16-22 years) and having six or more drinks in a session (32-42 years). Using latent class analysis, the participants were allocated to steady high, increased, moderate, and steady low groups according to their longitudinal profiles of HED. The PS scale (16-42 years) covered five mental complaints. The latent growth curve of PS was estimated in the HED groups for comparisons. In addition, the prospective associations between symptoms and HED were examined using cross-lagged autoregressive models. PS grew from 16 to 32 years, but declined after that, with women having higher level of PS than men. PS trajectory followed a path at highest and lowest level in the steady high and steady low HED groups, respectively. Symptoms predicted later HED, but the association in the opposite direction was not found. The more the HED trajectory indicated frequent HED, the higher was the level of PS throughout the follow-up. Results support the self-medication hypothesis, suggesting that alcohol is used to ease the burden of PS. More attention should be paid to alcohol use of people with mental symptoms in health services.

T106. Ethanol and Lithium Normalize Glutamate-Induced Elevation of Intracellular Sodium in Olfactory Neuroepithelial Cells of Bipolar Subjects, but not Non-Bipolar Controls: Evidence for Self-Medication Hypothesis

Alcoholism is highly prevalent in individuals diagnosed with bipolar disorder (BD). The nature of the association between alcoholism and bipolar disorder is not well understood. In the current study olfactory neuroepithelial progenitor cells (ONP) obtained from patients with BD and non-BD subjects were used to examine this relationship.

The Many Faces (and Potential Dangers) of Self-Medication as an Explanatory Concept for Substance Use

The self-medication hypothesis of addictive disorders maintains that individuals use substances to cope with dysphoric affect, and that painful emotional states are etiologically relevant to the development of a substance use disorder. While this hypothesis may be relevant for some, this paper proposes that self-medication understood in this fashion is an over-used concept. Furthermore, viewing substance use as being caused by some underlying emotional issue will affect how counselling is conducted and it is suggested that intervention may often be misguided. In this paper, other ways that substance use and mental suffering can become related that have nothing to do with emotional anguish being the causal agent for substance use will be elucidated. The implications that this has on counselling intervention will then be highlighted. Broadening of our understanding of self-medication and the many ways that substance use and psychological distress can become linked will help counselors to offer optimal care to this vulnerable population.

Association of childhood abuse and neglect with prescription opioid misuse: Examination of mediation by adolescent depressive symptoms and pain

Previous research has demonstrated an association between childhood abuse and neglect and prescription opioid misuse in adulthood. However, potential mechanisms underlying this association remain unclear. Based on the self-medication hypothesis and the existing research literature, we hypothesized that pain and depressive symptoms would mediate this association. Data were from Waves I (1994–1995) and III (2002) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 14,322). We conducted structural equation modeling to examine the association of childhood abuse and neglect with prescription opioid misuse in early adulthood and to assess for mediation by depressive symptoms and pain in adolescence. One in five respondents (20.1%) reported prescription opioid misuse in early adulthood. Childhood abuse and neglect was directly associated with an increase in the predicted probability of prescription opioid misuse (β = 0.232, p < 0.001). Pain, but not depressive symptoms, in adolescence was a significant mediator of this association (β = 0.019, p < 0.001). Pain may represent a complex stress-related response to early trauma among adolescents and may contribute to subsequent prescription opioid misuse as a coping mechanism. Results highlight the need to promote positive coping skills among adolescents who have experienced childhood abuse and neglect and underscore the importance of trauma-informed treatment services for individuals misusing prescription opioids.

The Influence of Daily Stress on Impaired Control through Emotion Dysregulation and Drinking Motives

Alcohol use disorder (AUD) can be explained by some emotion-based hypotheses such as the self-medication hypothesis and negative reinforcement model. Accordingly, the aim of this study was to explore the dynamic relationships between daily stress, emotion dysregulation and drinking motives in the prediction of impaired control to drink alcohol in a clinical male sample. Male patients with AUD (n=193) were recruited from alcohol centers of four psychiatric hospitals in South Korea. All participants completed a questionnaire that included the Hassles and Uplifts Scale, the Difficulties in Emotion Regulation Scale (DERS), the Drinking Motives Questionnaire (DMQ), and the Impaired Control Scale (ICS). The serial multiple mediation model analyses showed that daily stress resulted in impaired control through emotional dysregulation and drinking motives in order. Specifically, both emotional dysregulation and drinking motives in turn had partial mediation effects on the relationship between daily stress and impaired control on alcohol. Moreover, when drinking motives were entered as a mediator individually, the size of the indirect effect for coping motives was larger than that of enhancement motives was, suggesting that there might be no gender difference related to drinking motives. These results suggest that daily stress as a precursor indirectly influences impaired control through emotion dysregulation and drinking motives among patients with AUD. Considering the connection between stress and impaired control on alcohol via emotion dysregulation and drinking motives, future interventions need to focus on providing an individualized intervention that includes stress management and adaptive emotion regulation strategies.

Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization

ABSTRACTBackground: Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. Objectives: This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. Methods: We used nationally representative data from the 2009–2010 and 2011–2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Results: Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. Conclusions: We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen—and it is often minority Americans who lack access and trust. If minority Americans’ health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory

ABSTRACTThis article applies constructs from the Self-Medication Hypothesis and Social Cognitive Theory to explain the development of substance use and psychological distress after a disaster. A conceptual model is proposed, which employs a sequential mediation model, identifying perceived coping self-efficacy, psychological distress, and self-medication as pathways to substance use after a disaster. Disaster exposure decreases perceived coping self-efficacy, which, in turn, increases psychological distress and subsequently increases perceptions of self-medication in vulnerable individuals. These mechanisms lead to an increase in postdisaster substance use. Last, recommendations are offered to encourage disaster researchers to test more complex models in studies on postdisaster psychological distress and substance use.

A Qualitative Examination of the Self-Medicating Hypothesis Among Female Juvenile Offenders

Substance misuse among criminally delinquent youth has typically been described as a concurrent part of their participation in risky and delinquent behavior. Using Khantzian’s self-medication hypothesis, this article presents an alternative view by presenting qualitative data which suggests that substance misuse for female juvenile offenders may serve as self-medication for mental health problems stemming from early trauma, often at the hands of their families. Based on the narratives of 30 female juvenile offenders, this article examines the lived experiences of girls with childhood trauma and substance misuse, followed by arrest and incarceration. The paper concludes with recommendations for juvenile justice and child welfare practitioners.

Causal Factors of Increased Smoking in ADHD: A Systematic Review

ABSTRACTBackground: ADHD is a highly prevalent disorder and poses a risk for a variety of mental disorders and functional impairments into adulthood. One of the most striking comorbidities of ADHD is nicotine dependence. Youth diagnosed with ADHD are 2–3 times more likely to smoke than their peers without ADHD, initiate smoking earlier in life and progress more quickly and more frequently to regular use and dependence. Possible explanations for these increased risks are: (a) self-medication of ADHD symptoms with the stimulant nicotine; (b) ADHD symptoms like inattention and hyperactivity/impulsivity predispose for smoking initiation and impede smoking cessation; (c) peer pressure; and/or (d) common genetic or environmental determinants for ADHD and smoking. Objective: Identify the most probable causes of the high prevalence of smoking and nicotine dependence in subjects with ADHD. Methods: A systematic literature review was performed and the causality of the observed relations was ranked using the Bradford Hill criteria. Findings: ADHD medication reduces early smoking initiation and alleviates smoking withdrawal. Nicotine patches, bupropion and (probably) varenicline ameliorate ADHD symptoms. Imitation of and interaction with peers and genetic and environmental determinants may contribute to the comorbidity, but seem to contribute less than self-medication. Conclusion: Smoking is probably best explained by a combination of imitation, peer pressure and typical traits of ADHD. In contrast, the positive relation between ADHD and nicotine dependence is currently best explained by the self-medication hypothesis. This hypothesis has a clear pharmacological rationale and is supported by ample evidence, but awaits confirmation from longitudinal naturalistic studies.

The Relationships Between Hindrance Stressors, Problem Drinking, and Somatic Complaints at Work

Problem drinking is an important behavioral phenomenon with numerous implications for employees’ health and well-being within and outside the workplace. Although recent research has demonstrated that workplace stressors have effects on employees’ problem drinking, additional research is needed to examine the role employees’ problem drinking plays in the workplace stress–strain process. We draw from the transactional model of stress and the self-medication hypothesis to address this gap in prior research by offering a novel explanation for the indirect effects of hindrance stressors on employees’ somatic complaints at work through problem drinking. Overall, we find support for the hypothesized model using a time-separated data collection with a heterogeneous sample of employee respondents from the United States ( n = 223). This study extends prior stress research by making two important contributions to theory and research. First, we make an empirical contribution by examining problem drinking and somatic complaints at work, which are both understudied organizational phenomena that have importance to numerous organizational stakeholders. Second, we draw from the transactional model of stress and the self-medication hypothesis in a novel way that provides an important explanation for why hindrance stressors in the workplace are indirectly associated with somatic complaints at work through employees’ use of problem drinking as a self-medication coping mechanism.