Etiology of the addictive disorders

Question 1

Personality traits

Answer 1

HIGH LEVEL OF

• sensation seeking
• impulsivity
• neuroticism
• alexithymia

LOW LEVELS OF

• self-esteem
• emotional intelligence
• coping strategies

Question 2

Sensation seeking

Answer 2

Zuckerman - “seeking is varied, novel, complex and intense sensations and experiences, and the willingness to take physical, social, legal and financial risk for the sake of such experience”.

Question 3

Sesantion seeking + drugs

Answer 3

High level: stimulants, hallucinogens

Low levels: depressants

Question 4

Impulsivity

Answer 4

1. lower level of sensitivity for the negative consequences of the behavior
2. rapid, non-planned responses for stimuli
3. ignoring long term consequences

Question 5

Neuroticism

Answer 5

Big 5 - strongest relationship with N

Question 6

Alexithymia

Answer 6

Sifneos

4 main characteristics:

• difficulties in identifying emotions and in differentiation between emotions and their bodily responses
• difficulties in expressing emotions
• deficits in imaginations, poor level of fantasy work
• stimuli connected, external cognitive style

strong relationship with alcohol use, abuse

Question 7

Early psychoanalytic approach

Answer 7

• pleasure seeking, gratification, regression
• importance of oral functions, oral regression
• self-destruction, self-punishment

FREUD

• the only primary addiction: masturbation
• all the addictions are supplements of masturbation

Question 8

Rado

Answer 8

regression; coping with negative emotional states (depression, frustration, pain)

Question 9

Gover

Answer 9

Addiction as a defense mechanism against dissociation

Question 10

Fenichel; Savitt

Answer 10

Struggle against depression

Question 11

Abraham

Answer 11

Homoerotic tendencies behind alcoholism

Question 12

Rosenfeld; Chein

Answer 12

substance use = adaptive mechanisms: help the adolescents to cope with adult roles and help them to palliate anxiety

Question 13

Hartman

Answer 13

adolescence - attempt for palliate intrapsychic stress, painful emotions and depression

Question 14

Krystal and Raskin

Answer 14

Damage of stimulus barrier between person and others -> cannot dead themselves against painful emotions

Question 15

McDougal

Answer 15

overwhelming and elusive emotions -> obsessive way of regulating them

Question 16

Self-treatment theory (Wurmser)

Answer 16

Wurmser

Treating themselves against problems, painful emotions- helps them coping

3 basic emotions

• anger (disruption of ideal self and ideal world)
• shame (discrepancy between ideal self and real self)
• rejection (the object does not give everything that the person wants)

These principle emotions increase craving (“addictive search”) as a psychological hunger.

Question 17

Vicious cycle of obsessive substance use

Answer 17

1. narcissistic crisis: very low self-esteem derived from early trauma; disappointing in oneself; her/his self-expectations are collapsed, losing self-control
2. emotional regression: collapse of emotional defense -> overwhelming and archaic emotions
3. Searching for emotional defense: primitive, mainly avoidant type (denial, repression) or dissociative type (isolation, splitting, fragmentation)
4. Externalization: acting out of an unconscious conflict or problem; magical and omnipotent control over the uncontrollable
5. Aggression: motivated by narcissism; derived from early trauma; against external world (parents) and the self
6. Superego split: collapse of all the values, morals
7. pleasure: immature, mainly oral forms of pleasure, narcissistic goals –> increasing self-esteem, recreate the originial regressive and narcissistic state –> back to the 1 step of the cycle

Question 18

Self-medication theory

Answer 18

Khantzian

their drug of choice is the result of an interaction between the psychopharmacological action of the drug and the dominant painful feelings with which they struggle.

by unconscious choice

• depends on the deficits in personality, self-regulation, affect-regulation
• drug use a maladaptive coping: compensating neurological and developmental deficits

Question 19

Basic principles of psychodynamic theories

Answer 19

1. substance use is a manifestation of a latent psychological problem
2. problem in the regulation of affect and pathological object relations are core difficulties
3. the psychological problem causes substance use
4. the view substance abuse disorders as homogenous

Question 20

Family of drug users

Answer 20

• pathological family system
• family homeostasis
• sabotage against recovery
• as a secondary gain

Question 21

Family of an opiate addict (man)

Answer 21

• missing of father (not only physically)
• father: cold, rude, hardly available, full of negative emotions, in inferior position in the family -> blocked identification with the father
• mother: overprotective, laissez-faire, manipulative; symbiotic relation with the child