Lecture 3 and 4 Flashcards
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 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
Theories of addiction
Moral: sign of moral weakness, deviance
Disease: “sick role”, not reversible, genetic
Genetic/neuro-pharmacological: based on adoption and twin studies, limbic system, reward pathways/neurotransmitters
Psychological: classical/operant conditioning, positive reinforcement, associations
Socio-cultural: gender, age, SES, subculture
Bio-psycho-social: multiple contributing factors operate in combination
Psychological Theories
- Disease theories
- Behavioural theories (reinforcement)
- Cognitive/Cognitive behavioural theories
- Motivation and change theories
- Family and systems theories
The case of Mike
22 year-old male
Started binge drinking and cannabis when 15 yo
Currently drinking 10 standard drinks 5+ days/week
Cannabis use increased since failing uni and relationship break-up with his first serious boyfriend. Smoking cannabis nightly.
Reports feeling hopeless, depressed and anxious
States he was never close with his family. Sees them regularly, but things have become more difficult.
His father is a heavy drinker and is concerned to see his son making the same mistakes. High expectations to succeed from father.
Mike says drug use helps him to “feel better and forget”. He knows that his use is high and causing him harm, but feels there is nothing he can do about it.
He feels terrible after a heavy drinking session.
He believes he gets on better with people after he has had a few drinks, and can cope better with conflict with his family.
Disease Theories overview
Dependence is a symptom of physical or mental illness or disease
Dependence is caused by the presence of a specific gene or biochemical abnormality that precedes substance use
Inability to discriminate blood alcohol level
Increased sensitivity to alcohol
Abnormal brainwaves
Evidence comes from family, twin and adoption studies
12 Steps models
AA, NA, Al-Anon
Dependence as a “spiritual disease” and “lack of control”
Main premises (see Heather and Robertson 1997; Kaskutas, 2009)
Alcoholism is “all or nothing”. Problem or no problem.
Alcoholics are powerless over alcohol and experiences.
Alcoholism cannot be “cured”, only managed.
Disease is progressive and deterioration in condition is inevitable if drinking continues.
Support through attending groups, peer support, submitting to a higher power
Mechanisms of theory not well explained
Limited research evidence base
Heavy drinkers can control use, many dependant users do return to controlled use, no evidence that the disease is ‘progressive’.
This is an example of abstinence vs. harm reduction approaches.
Treatment outcomes from 12 step programs-associated with greater friends, spiritual connection, finding meaning in life (Kaskutas, 2009)
Psychoanalytic View
Nature and nurture Unconscious processes that govern the id, ego, & superego Importance of childhood experiences Variety of theories: Fixated at the “oral” stage Id –drive reduction theory. Ego – “self medication”
Psychoanalytic Shared Assumptions
Psychoanalytic shared assumptions:
Drug use is a symptom of an underlying psychological disorder
Indicates severe psychopathology
Psychological problems are assumed to cause substance abuse, but not usually recognised as a consequence of use
Addiction is considered a uniform disorder
Treatment via the therapeutic relationship and specific psychoanalytic techniques
Consumption provides relief from conflict generated by oral fixation; or repressed psychological conflict (see Rassool, 2011)
Jellinek 5 Types of Alcoholics ABGDE
alpha - pure psychological addiction
beta - continuous heavy drinking leading to medical complications, but psychological or physical dependence not evident
gamma - increased tolerance, withdrawals, cravings and loss of control
delta - as above with inability to abstain
epsilon - intermittent binge drinking interspersed with abstinence/controlled use
Cloninger, Wennberg 1987 Two Alcoholic Types
Type 1 (late onset): high reward dependency, high harm avoidance, and low novelty seeking Type 2 (early onset): lower reward dependence, low harm avoidance*, high novelty seeking Some research is inconsistent*
Personality Theory
Group of distinct personality characteristics that distinguish alcoholics from other individuals
Many ideas:
Predisposing factor (‘addictive personality’)
Consequence of dependence
Independent (personality trait and dependence)
Limited evidence of ‘addictive personality’ per se
Related to specific personality characteristics (e.g., sensation seeking)
Personality Predictors of Drug Use
Personality predictors of drug use (e.g., McGue 1995; Rassool, 2011)
Behavioural disinhibition (impulsivity)
Emotional negativity (negative mood, depressive PD)
Other personality features (e.g., narcissism)
Used to enhance sensation and avoid pain
Personality characteristics are also related to drug of choice
- Heroin patients show greater novelty seeking than alcohol patients (Le Bon et al, 2004)
- Some research considers internal vs. external stressors and uses MMPI personality profiles to categorise drug of choice (Lawson & Winstead, 2008)
Parts of the brain involved in addiction
- Cortex
- Limbic System
- Brain stem
Endorphin-Deficiency Theory
Drugs of abuse target the brain’s pleasure centre
Behavioural Theories
Only considers observable/measurable behaviour Behaviour is a consequence of learning Four main types of conditioning Classical conditioning Operant conditioning Modelling Tension reduction
Classical Conditioning Models
Classical conditioning models 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 CS more important than CR
Operant conditioning models
Focuses on reinforcing properties of drugs, and the likelihood of people repeating immediately pleasurable experiences (and avoiding unpleasurable experiences)
Three main reinforcement types:
Positive reinforcement (i.e., drugs can cause pleasurable sensations)
Negative reinforcement
Punishment
Modelling behavioural theories
People learn favourable attitudes and expectation about drinking based on how the behaviour is modelled.
Lowers the risk of harm if one does not have to experience negative consequences personally
Increases the likelihood of pleasant experiences learned from others
Maintenance associated with past associations with drug-taking environments/situations (see Rassool, 2011)
Cognitive Model
Focuses on the thoughts/beliefs, and impact on behaviours and feelings
The way people interpret specific situations influences feelings, motivations and actions.
Layers of beliefs
Cognitive Dissonance
Conflicting beliefs (cognitive dissonance)
Conflict between the desire to use drugs and the desire to be free of drugs e.g. “I should not use alcohol” vs “It’s OK to have a drink just this one time”
Leads to a cycle of behavioural, emotional and thinking patterns
Cognitive-behavioural: thoughts and behaviours are learnt and therefore can be ‘unlearnt’ (CBT)
