3. Theories of Substance Use Flashcards
What is a theory?
“…a set of descriptors or principles put forward as an explanation of facts, findings, observations or experiences…allows us to organise and make sense of relationships among variables of interest”
why are theories important in the context of drugs?
it explains why a drug is more or less addictive, makes sense of similar behaviour and explains cycle of increasing dysfunctional involvement with drugs
In what contexts do theories explain why drugs are more or less addictive?
in one society than another, for one individual and not another, for the same individual at one time and nother another
with regards to making sense of similar behaviour, what are theories supposed to look at?
theories are not supposed to look at alcohol and drugs, but rather other compulsive behaviours and how we can transfer the understanding across
what questions do theories tough on when explaining the cycle of increasing dysfunctional involvement with drugs?
why do people continue in engaging in something that is often dysfunctional?
what must a theory that explains the cycle of increasing dysfunctional involvement with drugs involve?
it must be faithful to the lived human experience, hence it must be based on reality
what are theories a matter of?
perspective. for example. is there a difference between someone having to take daily prescribed drugs and someone taking elicit drugs daily?
why do people use substances?
- To enjoy the experience and short term effects
- To feel confident
- To “break the rules”
- To be part of the subculture
- To relieve boredom
- Peer influence
- Family factors
- Community factors
why do people first start engaging in drugs?
o peer pressure
o fun
o curiosity
o cultural expectations (e.g. at weddings, you drink)
why do people continue to use addictive substances?
- To counter the unpleasant effects of prescribed medications
- To continue the habit
- To avoid unpleasant feelings
- To satisfy cravings
- To avoid withdrawal symptoms
- To counter the effects of other drugs (e.g., benzos after speed)
- Gateway theory
what is the gateway theory?
Using one drug to lead to another
what are the theories of drug addiction?
Moral, disease, genetic/neuro-phamacological, psychological, socio-culural, bio-psycho-social
what is the general concept of the moral theory of addiction?
sign of moral weakness, deviance
what is the general concept of the disease theory of addiction?
“sick role”, not reversible, genetic
what is the general concept of the genetic/neuro-pharmacological theory of addiction?
based on adoption and twin studies, limbic system, reward pathways/neurotransmitters
what is the general concept of the psychological theory of addiction?
classical/operant conditioning, positive reinforcement, associations
what is the general concept of the socio-cultural theory of addiction?
gender, age, SES, subculture
what is the general concept of the bio-psycho-social theory of addiction?
multiple contributing factors operate in combunation
what are the psychological theories of drug addiction?
disease theories, behavioural theories, cognitive/cognitive behavioural theories, motivation and change theories and family and systems theories
according to the disease theory, what is dependence a symptom of?
dependence is a symptom of physical or mental illness or disease
according to the disease theory, what is dependence caused by?
the presence of a specific gene or biochemical abnormality that precedes substance use
according to the disease theory, what do the genes or biochemical abnormalities that precede substance use do to precede substance use?
causes an inability to discriminate blood alcohol level, increased sensitivity to alcohol, brainwaves
where does most of the evidence of disease theories come from
there is an extensive history of studies on the disease theory where most of the evidence comes from family, two and adoption studies
what are the common approaches to disease theories in the community
12 step models, psychoanalytic view, personality theories, genes/genetics, endorphin deficiency theory
what does the 12 step model believe dependence is?
it is a spiritual disease and a lack of control
what are types of 12 step models?
AA, NA, Alcoholics-Anon
what are the main premises of the 12 step model
o Alcoholism is “all or nothing”. Problem or no problem.
o Alcoholics are powerless over alcohol and experiences.
o Alcoholism cannot be “cured”, only managed.
o Disease is progressive and deterioration in condition is inevitable if drinking continues.
o Support through attending groups, peer support, submitting to a higher power.
o support groups
how are the mechanisms of this theory explained?
not very well, as there is limited evidence based research
what does the 12 step model fail to evidence?
that the disease is progressive. Heavy drinkers can control their use, and many dependent users do return to controlled use. This is an example of abstinence vs harm reduction approaches
what are 12 step programs associated with?
greater friends, spiritual connection, finding meaning in life
what is one of the most common treatments to drug addiction in the world?
12 step model
how does the 12 step program compare to cognitive behavioural therapy?
does very well
what is the main premise of the psychoanalytic view?
nature and nurture
what does the psychoanalytic view comprise of?
unconscious processes that govern the id, ego and superego.
what is the id?
it is the needs - food, sex, desires
what is the ego>
manages a balance between the id and superego?
what is the superego?
moral
what is important in the psychoanalytic view of drug addiction?
childhood experiences
what is the theory encompassed in the psychoanalytic view if drug addiction?
Drug addiction is fixated at the ‘oral’ stage of development. i.e. a person that engages in drug use had a disruption to their secure attachment and uses drugs to solve it. e.g. smokers struggled to breast feed, thus smoke to relace that loss
in regards to the psychoanalytic view of drug addiction, what is the theory behind the id?
drive reduction theory
in regards to the psychoanalytic view of drug addiction, what is the theory behind the ego?
self medication
what does the psychoanalytic view of drug addiction believe will cure drug addiction?
managing early childhood distresses
what are the shared assumptions of the psychoanalytic view of drug addiction?
o Drug use is a symptom of an underlying psychological disorder - drug use is not seen as a normative behaviour
o Indicates severe psychopathology - mentally unwell
o Psychological problems are assumed to cause substance abuse, but not usually recognised as a consequence of use
o Addiction is considered a uniform disorder
what is the treatment of drug addiction according to the psychoanalytic view of drug addiction?
treatment via therapeutic relationship and specific psychoanalytic technices
what is the process of treatment according to psychoanalytic view of drug addiction?
about building a trusting warm relationship with somebody to resolve those childhood issues thus doesn’t rely on drugs to attempt to solve those psychological problems
what does consumption of drugs provide according to psychoanalytic view of drug addiction?
relief from conflict generated by oral fixation; or repressed psychological conflict
according to the personality theories, what is the 5 types of alcohol provided by Jellinek (1960)?
alpha, beta, gamma, delta and epsilon
according to the personality theories, what is the alpha alcoholic?
pure psychological addiction
according to the personality theories, what is the beta alcoholic?
continuous heavy drinking leading to medical complications, but psychological or physical dependence is not evident
according to the personality theories, what is the gamma alcoholic?
increased tolerance, withdrawals, cravings and loss of control
according to the personality theories, what is the delta alcoholic?
increased tolerance, withdrawals, cravings and loss of control (similar to beta) however adds the inability to abstain
according to the personality theories, what is the epsilon alcoholic?
intermittent binge drinking interspersed with abstinence/controlled use
what are the contemporary types of alcoholics according to Cloninger (1987; 1991) ; Wennberg et al., 2014?
type 1 (late onset) and type 2 (early onset)
what are the characteristics of a type 1 alcoholic?
high reward dependency, high harm avoidance, and low novelty seeking
what do type 1 alcoholics tend to do?
o ‘I need you to say good things about me’ – if you say im okay im okay
o avoid conflict
o not risk takers – nervous and anxious people
what are the characteristics of a type 2 alcoholic?
lower reward dependence, low harm avoidance*, high novelty seekers
what do type 2 alcoholics tend to do?
o the risk takers
o sensation seeking
o I don’t care what you think about me
o I don’t care about what society has to say
what is there inconsistent research about with regard to type 2 alcoholics?
that they have low harm avoidane
where are most people characterised in the contemporary categories of alcoholics?
between type 1 and type 2
How do personality theories determine why you are addicted?
look at how you grew up and your personality
what does the personality theory suggest that makes an alcoholic different from other individuals?
a group of distinct personality characteristics
what are the main ideas of the personality theory?
o Predisposing factor (‘addictive personality’)
o Consequence of dependence
o Independent (personality trait and dependence)
what is there limited evidence for in the personality theory?
addictive personalities
what are addictive personalities related to?
specific personality characteristics (e.g. sensation seeking)
what puts people at higher risk of drug addiction according to the personality theory?
different traits. • e.g. athletes: highly driven, high perfectionist - seen as a greater risk of substance use
what are the personality predictors of drug use according to psychologists like McGue 1995; Rassool, 2011?
o Behavioural disinhibition (impulsivity)
o Emotional negativity (negative mood, depressive PD)
o Other personality features (e.g., narcissism)
o Used to enhance sensation and avoid pain
what are personality characteristics also related to according to the personality theory?
related to the drug of choice
what to heroine patients show according to the personality theory?
greater novelty seeking than alcohol patients (Le Bon et al., 2004)
what do some researches consider when determining the drug of choice according to the personality theory?
internal vs. external stressors and uses MMPI personality profiles to categorise drug of choice
where can the genes that cause alcohol use disorders be found according to the genetic theory?
dopaminergic, glutamatergic, GABAergic, opioidergic, sertotoninergic, annabinoid, noredrenaline, circadine rhythem systems
what are environmental factors contribute to alcohol use disorders according to the genetic theory?
culture/peer influences, age of first use, alcohol availability, childhood behaviour disorders, childhood maltreatment, parental attitudes, stress
what parts of the brain are involved in addicition according to the genetic theory?
cortex, limbic system, brain stem
what is the reward pathway according to the genetic theory?
starts at the Ventral Tegmental Area in the brain, then to the nucleus accumbens then to the prefrontal cortex
where does the activation of the reward pathway begin when using heroin according to the genetic theory?
at the VTA (ventral tegmental area)
where does the activation of the reward pathway begin when using cocaine, heroin and nicotine?
at the nucleus accumbens
what are the brain circuits, (from VTa, Nucleus accumbens and Frontal Cortex) important for?
natural rewards such as food, music and sex
what is dopamine increase a response to?
natural rewards such as good
what happens to dopamine increase when cocaine is taken?
dopamine increases are exaggerated and communication is altered
What does the behavioral theories consider?
it considers only observable/measurable beahaviour
what is behaviour a consequence of according to the behavioural theories?
learning
what are the 4 main types of conditioning according to the behavioural theories?
classical, operant, modelling, tension reduction
what is classical condition in relation to drugs?
Sights, smells and sounds consistently associated with drug use elicit physiological and psychological responses that lead to drug seeking behaviour. Conditioned stimuli (CS) – cues and triggers. Conditioned response (CR) – physiological and psychological responses
what does operant conditioning focus on?
Focuses on reinforcing properties of drugs, and the likelihood of people repeating immediately pleasurable experiences (and avoiding unpleasurable experiences)
what are the three main reinforcement types?
positive reinforcement, negative reinforcement, punishment
According to the modelling model of behavioural theories, what do people learn?
favourable attitudes and expectation about drinking based on how the behaviour is modelled?
According to the modelling model of behavioural theories, what lowers the risk of harm of drugs?
if one does not have to experience negative consequences personally
According to the modelling model of behavioural theories, what does modelling increase the likelihood of?
pleasant experiences learned from others
According to the modelling model of behavioural theories, what is maintenance of drug use assocated with?
past associations with drug-taking environments/situations
what is the tension reduction theory?
Tension in society -> demands relief -? Problem of elimination of reduction of conditions that create tension OR problem of finding a mode for relief of tension
what are the three elements of the tension reduction theory
A - Antecedents
B - Behaviour
C - consequences (reinforcing)
what are possible antecedents in the tension reduction theory?
TRIGGERs - a situation, thought or feeling
what are the consequences in the tension reduction theory?
PAYS OFF - immediate outcome that maintain the behavour
what are the models and theories that underpin the cognitive and cognitive behavioural theory?
- Cognitive model
- Expectancy theory
- Social learning theory
- Relapse prevention
- Core beliefs (schemas)
what does the cognitive model focus on?
focuses on the thoughts/beliefs, and impact on behaviours and feelings. the way people interpret specific situations, that influences feelings, motivations and actions
what does “layers of belief” mean in the cognitive model?
core beliefs and reactions - we are not conscious of these
what does the cognitive model look into?
your thoughts and how you make sense of thigns and how they make you feel the way you feel
what is there a lot of in the processes of the cognitive model?
interpretation
what does the cognitive model believe causes drug addiction?
conflicting beliefs - cognitive dissonance
what are hte conflicting beliefs that cause drug addiction according to the cognitive model theory?
conflict between the desire to use drug and the desire to be free of the drug
what do conflicting beliefs in the cognitive model lead to?
a cycle of behavioural, emotional an thinking patters
what does the cognitive behavioural theory suggest?
thoughts and behaviours are learnt and therefore can be unlearnt
what factors does the social learning theory encompass?
personal factors, environmental and behaviour
personal factors/views + environment =
behaviour
what is a popular term used in the social learning theory?
belinging
according to the expectancy theory (Bandura, 1969) what are the two specific cognitions?
outcome expectancy, and self efficacy
what is outcome expectancy with regards to drugs?
beliefs abut effects and outcomes of using
what is self efficacy?
belie in ones own ability to effect change
what would someone with high outcome expectancy be likely to say?
nothing else will fix now i feel
what does relapse prevention, in regards to the expectancy theory. aim to do?
reduce high risk situations and increase alternative coping strategies and self-efficiacy
what causes relapses according to the expectancy theory?
Interaction of high risk situations (cues/triggers) with coping response and expectancy (outcome and self-efficacy)
what is a word to describe the motivational and change theories
transtheoretical
What is motivational interviewing
intrinsic motivation is a necessary and sufficient factor to initiate behaviour change
what are the elements or factors in the motivational and change theories?
precontemplation, contemplation, preparation, action, maintenance, relapse
what is involved in precontemplation in the motivational and change theories?
No intention of changing behaviour
what is involved in contemplation in the motivational and change theories?
aware a problem exists. No commitment to action
what is involved in preparation in the motivational and change theories?
intent upon taking action
what is involved in the action phase in the motivational and change theories?
active modification of behaviour
what is involved in the maintenance phase in the motivational and change theories?
Sustained change - new behaviour replaces old
what is involved in the relapse phase in the motivational and change theories?
fall back into old patterns of behaviour
what is involved in the precontemplation phase in the motivational and change theories?
No intention of changing behaviour
according to the family systems theory, what are determinants of behaviour based on?
based on an individual’s rle within a system
what do family and other systems (e.g. peers) have a role in according to the family systems theory?
have a role in starting/maintaining substance use
what are the common elements of a family systems theory?
boundaries, reciprocal causality, homeostasis
what are boundaries in the family systems theory?
- appropriate way to act and inappropriate way to act
* and the blur of the boundaries
what is homeostasis in the family systems theory?
try to fit within the system
