I agree that it could be self-sabotaging.. However, the reasons are soooo complex that I think it is hard to make a wide assumption or judgment like you have made. I refused drugs for months, then avoided taking them for almost two weeks after I filled them. Not b/c I didn't want to get better, but b/c my anxiety, intrusive, irrational thoughts got in my way. I do not consider that a form of SI.. I have struggled with SI, it they comes from two totally different thoughts and emotions. Other don't take them b/c money is an issues, or they can't stand the side-effects, etc.