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

Abstract

This 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.

Keywords: Disasters; psychological distress; self-efficacy; self-medication; social cognitive theory; substance use.

Figure 1.

A conceptual diagram of a conditional process model illustrating the conditional effects of disaster exposure on substance use (e.g. cigarettes, alcohol, and marijuana). The focus of this model is complex sequential mediation pathway (X→M1→M2→M3→Y). The effect of disaster exposure on substance use is mediated through perceived-coping self-efficacy, psychological distress, and self-medication in that sequential order. Collective efficacy acts as a buffer against the deleterious effects of disaster exposure. Specifically, collective efficacy protects against the harmful effects disaster exposure has on self-efficacy, psychological distress, self-medication, and substance use. If collective efficacy is measured after the disaster, it could also serve as another pathway to substance use (as denoted by the dotted line). Contextual factors, such as social support and socioeconomic status, can be used to identify differences in perceived coping self-efficacy among sub-groups and vulnerable populations who are at an increased risk for postdisaster psychological distress, feelings of self-medication, and postdisaster substance use. Further contextual factors can be included as confounders to improve the estimation of causal direct and indirect pathways.