addiction basics

Question 1

psychodynamic approach-

Answer 1

Psychodynamic perspectives
* Ego manages the basic impulses of the Id with the moral
conscience of the superego.
* Early psychodynamic formulations insisted that substance
dependence stemmed from unconscious self-destructive
tendencies of the Id. Treatment therefore focuses on
reducing these drives.
* More contemporary views – deficiencies of the ego, which
leads to a vulnerable and dysregulated self. Focus is on
developing ego-strength (i.e. ability to cope with external
demands).
* Psychodynamic approaches rarely distinguish between the
types, nature or severity of addiction – focusing instead on
the underpinning psychological issues.

Question 2

psychodynamic approach 2

Answer 2

The psychodynamic perspective of addiction views substance use and addictive behaviors as being rooted in unconscious conflicts, early childhood experiences, and emotional pain. It suggests that addiction serves as a coping mechanism to deal with unresolved psychological distress. Here are some key ideas from this perspective:

Unconscious Conflicts – Addiction may stem from deep-seated unconscious conflicts, often related to unmet childhood needs, trauma, or repressed emotions.

Self-Medication Hypothesis – People may use substances or engage in addictive behaviors to numb painful emotions, such as anxiety, depression, or unresolved grief.

Attachment and Early Relationships – Poor attachment in early childhood, such as neglect or inconsistent caregiving, can lead to emotional insecurity and difficulties in regulating emotions, making a person more vulnerable to addiction.

Defense Mechanisms – Addicts might unconsciously use substances as a defense mechanism to avoid confronting painful feelings or realities (e.g., denial, repression, or projection).

Personality Factors – Certain personality traits, such as low self-esteem, impulsivity, or difficulty managing stress, may contribute to addictive behaviors.

Repetition Compulsion – People may unconsciously repeat negative patterns from their past, including self-destructive behaviors like addiction, as a way to replay unresolved psychological wounds.

Treatment Approach:
From a psychodynamic perspective, therapy focuses on uncovering and resolving unconscious conflicts, increasing self-awareness, and helping individuals develop healthier ways to cope with emotions. Psychoanalysis, talk therapy, and exploring childhood experiences are common methods used.

Question 3

more contemporary perspectives

Answer 3

Substance related addictions are now recognised
as mental disorders, with evidence to suggest they
develop and are maintained via a complex
interplay between biological, psychological,
environmental, and social factors.
Views towards individuals who have become
‘addicted’ can still often err towards blame and
criminalisation despite the scientific evidence.

Question 4

broad perspectives

Answer 4

addiction as an immoral conduct-
v Behaviours are freely
chosen
v Can therefore be blamed
for their addiction.
v Punishment and punitive
actions; addict not
deserving of care or help.

this approach is Advantages: Simple and clear
explanation that requires little further
investigation.

BUT:
* Addiction is anything but simple!
* Pharmacological, biological,
economic, psychological, and social
factors implicated.
* Is it really ‘freely chosen’?
Impairments in self-control.
* Punishments are ineffective at
reducing addictive problems in the
population.

vs
exercise addiction is a disease!
v Disease that causes excessive
drinking/drug use
v Genetic origins?
v Victims of the illness, it is not
freely chosen
v The illness itself impacts on
decision making and selfregulation abilities.
v Deserving of compassionate
care and medical treatment.

vRemoves addiction from the
moral realm
vReduced stigma
vImproved allocation of
resources and treatment to
care for those with
addictions.
vUncertainty about the
underlying pathogenesis of
the disease model
approach.

Question 5

disease models of addiction

Answer 5

Susceptibility and/or exposure models
* The progressive course of addiction
* The role of tolerance and withdrawal
Model Evidence

Susceptibility model – genetic
vulnerability=Familial transmission (e.g., Volkow & Baler, 2014) /Gene environment interactions
Polygenetic contributions

Exposure model – effects of drugs on the
brain/ Activation of (and subsequent desentisation)
mesolimbic dopamine pathway

Question 6

tolerance

Answer 6

Tolerance- symptom of disease model

• Ingestion of addictive substances activates pathway in the brain that result in the
  release of dopamine à Euphoria
• Chronic activation of this pathway results in desensitisation, and lower dopamine
  release.
• User increases amount consumed in order to achieve the same ‘high’
• Tolerance a symptom of
  dependence
  1) Ingestion of substance for dopamine
  release
  2) Desensitisation and reduced ‘high’
  3) Increasing amount consumed to reproduce
  initial euphoria

Question 7

withdrawls

Answer 7

Withdrawal- symptom of disease model

• Physical symptoms of withdrawal are deemed to be a key indicator of
  dependency in disease models.
• Varies according to type and amount of drug consumed prior to cessation
• Unpleasant symptoms provide motivation for further drug ingestion to relieve
  or avoid discomfort.
• Presence of withdrawal symptoms likely to just indicate more severe addiction.
• Symptoms of tolerance and withdrawal are not necessary for addiction
  diagnoses

Question 8

conditioning models

Answer 8

The reward (euphoria) that follows the ingestion of an opioid/alcohol reinforces the behaviour of
ingesting the substance (operant conditioning)
* Positive versus negative reinforcement

Negative reinforcers
Withdrawal symptoms –
e.g., tremors, restlessness,
anxiety, insomnia, cravings.

Positive reinforcers:
Euphoria
Enhanced sociability
Peer acceptance

• Generalisation effects
• Discrimination
• Strength and number of reinforcers that follow a behaviour influence the likelihood of the behaviour
  (McAuliffe & Gordon, 1980).

Question 9

addiction as maladaptive behaviours

Answer 9

v Addiction is learned
v Learning takes place at cognitive
and neurological levels (Lewis,
2017).
v Addiction as a “well-learned
habit”.
v Victims of destructive
living/learning conditions (e.g.,
early childhood trauma, poverty),
exposure to crime.
v Difficulties with self-regulation in
difficult environment.
v Treatment aims to enhance
behavioural skills and thus disrupt
and change their habits and coping
mechanisms.

v Removes addiction from the
moral realm and moves away
from the medical model.
v Challenges around changing
individuals’ behaviours, but
also in changing the
sociocultural environment that
may contribute towards
addiction development.

very different from psychodynamic