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A meta-analysis was conducted to test a core feature of the self-medication hypothesis of substance use disorders (SUDs) that posits that SUDs are associated with failures of ego control. This hypothesis was tested by quantitatively synthesizing studies that used the delay discounting task in individuals with SUDs compared with nonclinical controls. An additional aim of the study was to identify variables that might moderate the relationship between SUDs and delay discounting task performance. The results were based on 10 studies that consisted of 925 participants who used a variety of psychoactive substances, and all studies used matched-groups designs. Participants with SUDs showed significant failures in ego control compared with nonclinical controls (d = 0.587). Variance across studies was nil, and therefore no moderators were sought. The results of this study support the self-medication hypothesis and suggest that SUD treatment should focus on improving ego control. The results also show that the delay discounting task is an experimental method that can be used to operationalize a number of psychoanalytic constructs and thus opens the door to further psychoanalytic experimental research on failures of ego control.
We thank George Ainslie, Robert F. Bornstein, Jason Gold, and Louis Rothschild for their thoughtful comments and suggestions on earlier versions of this article. We would also like to thank Warren Bickel for his assistance in identifying relevant studies for this meta-analysis. An earlier version of this study served as the basis of a master's thesis for Philip Murawski that was conducted under the supervision of William H. Gottdiener. This research was partially supported by National Institute on Drug Abuse Grant No. 1R03DA018370-01A1 to William H. Gottdiener. Opinions in this article do not necessarily represent the official positions of the U.S. government or the John Jay College of Criminal Justice, City University of New York.