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Background

As outlined in Chapter 1, and previously by Taylor et al.(1997), Krystal and Raskin (1970) described specific cognitive and affective characteristics among drug-dependent and alcoholic patients in the same year that Nemiah and Sifneos (1970) were observing similar characteristics among patients with classic psychosomatic diseases. Krystal and Raskin observed that drug addicts seemed to experience their affects in an undifferentiated, global, primarily somatic way, and had considerable difficulty tolerating painful affects. Krystal (1975, 1988) adopted the term “alexithymia” and suggested that the impaired capacity of substance-dependent individuals to tolerate, identify, and manage affects leads them to use drugs to block or regulate affects. Khantzian (1982) similarly observed that drug addicts have enormous difficulties in regulating and expressing affects and rely on drugs to obtain relief from either overwhelming or diffuse and confusing emotions, or even a painful absence of feelings. These observations led Khantzian (1985, 1997) to propose a “self-medication hypothesis”, according to which individuals are