Task 1 Flashcards
Cotman and McGaugh – 4 very general classes of drugs subject to abuse:
Narcotics,
General depressants
Stimulants
Hallucinogens
Wakefield
Wakefield: mental disorder is a “harmful dysfunction”- the failure of an internal mechanism to perform its naturally selected evolutionary function, causing harm to an individual
The onset of alcoholism was ordered into 4 specific phases (Jellinek, 1943):
The onset of alcoholism was ordered into 4 specific phases (Jellinek, 1943):
1. pre-alcoholic phase: drinking mostly socially motivates and involves the experiences of “relief drinking”
- prodromal phase: drinking becomes the principal means of escape from tensions and problems; consumption of large amounts, blackouts, sneaking drinks, shame, chronic hangovers etc.
- crucial phase: individual moves into addictive drinking, involving loss-of control, morning drinking, development of alibis, rule to (unsuccessfully) limit drinking, antisocial behavior, losses of family, friend, or workplace relationships
- chronic phase: self-control is utterly destroyed, and the sufferer can only move toward further deterioration
Subtypes of alcoholism, Jellinek, 1960:
Subtypes of alcoholism, Jellinek, 1960:
– Alpha alcoholism (problem drinking)
– Beta alcoholism (pathophysiological effects of drinking in the absence of strong psychological or physical dependence)
– Gamma alcoholism (classic variety of alcoholism as described above)
– Delta alcoholism (similar to gamma but without the loss-of-control)
– Epsilon alcoholism (periodic binge-drinking)
The Alcohol Dependence Syndrome, ADS, 1976
compulsive use patterns and the incentive salience of alcohol use
- Seven dimensions: tolerance, withdrawal, use to avoid withdrawal, subjective compulsion to use, salience of use in the person’s life, stereotyped use patterns, and rapid reinstatement of frank addiction upon return to use after a period of abstinence
- Can also be used for other substances
Seven dimensions
Seven dimensions: tolerance, withdrawal, use to avoid withdrawal, subjective compulsion to use, salience of use in the person’s life, stereotyped use patterns, and rapid reinstatement of frank addiction upon return to use after a period of abstinence
- Can also be used for other substances
substance abuse
substance abuse = hazardous use or continued use despite social consequences (broader criterion array than DSM III)
- Type I:
Type I:
- Usually described by no more than moderate heritability, gradual onset in maturity, absence of gross character pathology, relatively contained consequences in the context of a moderately abusive drinking pattern, and is about as common in females as in males
- Less likely to have genetic influence, generally milder course, and consequences
Type II:
Type II:
- typically described as having high heritability, early onset, association with antisocial traits, severely uncontrolled drinking, severe psychosocial consequences, and male gender dominance
Type II:
Type II:
- typically described as having high heritability, early onset, association with antisocial traits, severely uncontrolled drinking, severe psychosocial consequences, and male gender dominance
Cultural Perspectives on Substance Use Disorders
- universalistic:
- focuses on common elements across cultures and is exemplified by descriptions of ADS
- permits cross-cultural comparisons, culture specific manifestations of illness may be ignored
- relativistic:
- emphasizes the influence of culture on the manifestation and content of illness and asserts that the impact of culture in defining and shaping illness can lead to culturally specific or culture-bound syndromes
Current Diagnostic System for Substance Use Disorders
- ICD-10:
ICD-10:
- Substance dependence (require presence of 3 or more criteria) and harmful use (one criterion enough)
- 6 criteria: tolerance; withdrawal; craving; difficulties in controlling the onset, termination or levels of use; much time spent using or reduced activities in favor of drinking; and the harmful use symptom
DSM 5 includes categorical dimensional approach
DSM 5 includes categorical dimensional approach
- The dimensional approaches utilize the concepts of “spectrum nosology”, which emphasizes the subthreshold manifestations of disorder, the importance of scaling severity among those who are above a diagnostic threshold, and non-criterion signs and symptoms associated with a disorder
DSM 5
DSM 5 includes categorical dimensional approach
- The dimensional approaches utilize the concepts of “spectrum nosology”, which emphasizes the subthreshold manifestations of disorder, the importance of scaling severity among those who are above a diagnostic threshold, and non-criterion signs and symptoms associated with a disorder
- DSM-5 describes symptom count ranges that correspond to “mild,” “moderate,” and “severe” SUD
- Level of severity can be used to make clinical decisions about the appropriate level of care
heavy episodic drinking
heavy episodic drinking – drinking five or more drinks on the same occasion
heavy alcohol use
drinking five or more drinks on the same occasion on 5 or more days in the past 30 days
Tabaco Use
Usually starts in adolescence, escalates soon thereafter, and then stabilizes during young adulthood, with a gradual decline into later adulthood
- Peak around age 24
- Stable usage after age 30 for daily smokers
Cannabis Use
Cannabis Use
- Lifetime consumption reported by about 50%
- Peak initiation age is 17
- DSM-IV dependence criteria are met by 10-18% of cannabis users
- Higher probability for dependence if initiation at younger age
Summary - Jackson & Sartor
- data indicate that use of alcohol, tobacco, and illicit drugs increases over adoles¬cence, with young adulthood comprising the period of peak prevalence
- Smoking exhibits a more gradual decline and a slightly later peak than alcohol and drug use.
Heavy smoking tends to show greater stability than non-heavy smoking, attesting to the addictive nature of smoking - males show greater prevalence of alcohol and drug use than females, the literature has failed to identify gender differences in smoking over the lifespan.
-Substance use rates in adolescence tend to be greatest in whites and lowest in blacks, although for smoking and, to a lesser extent, for drinking, rates for blacks approach and even surpass rates for whites by young adulthood.
Onset & Alcohol
- Early drinking onset is associated with an increase in the likelihood of numerous short- and long-term adverse outcomes
- Likelihood of developing alcohol dependence reduce by 5-9% for each year that drinking onset is delayed
- Youth with later onset (>14) progress faster to heavier drinking but are less likely than early onsetters to develop alcohol dependence
- Decline in alcohol use in adulthood primarily has been attributed to major changes in social role status (work, marriage, parenthood)
Onset & Alcohol
- Early drinking onset is associated with an increase in the likelihood of numerous short- and long-term adverse outcomes
- Likelihood of developing alcohol dependence reduce by 5-9% for each year that drinking onset is delayed
- Youth with later onset (>14) progress faster to heavier drinking but are less likely than early onsetters to develop alcohol dependence
- Decline in alcohol use in adulthood primarily has been attributed to major changes in social role status (work, marriage, parenthood)
Onset & tabacco
- Likelihood of daily smoking and dependence are higher for those with an early onset
- Early onset smoking is associated with illicit drug use
- 3 stages: nonsmoking, experimentation, and regular/daily smoking
Transtheoretical Model of smoking
Transtheoretical Model
- 3 classifications for smokers: pre-contemplation, contemplation, and preparation
- 2 classifications for former smokers: action, maintenance
- strategies to bring about change, including both experiential processes (e.g., self-reevaluation) and behavioral processes (e.g., self-liberation)
Risk factors tabaccco use
Risk factors:
- most robust predictors of onset and progression are peer smoking and peer approval
- accessibility is large risk factor (e.g. by being offered cigs from friends)
- parent smoking also influences onset and progression
- onset and transition is more prominent in whites
- lower SES increases likelihood
- girls probably more susceptible to peer influence
Natural Recovery from Heavy/Problem Substance Use
- remission without treatment is norm
- ¾ problem drinkers resolve problems without treatment
- controlled use rather than abstinence is considered a legit form of recovery
- role socialization: individuals change their substance use to be compatible with expectations from certain social roles
- anticipatory socialization: substance use is reduced in anticipation of a role to be assumed
Implications of familial influences for prevention and treatment
— Providing treatment for parental SUDs
— Interventions to improve parenting practices and strengthen positive parent-child relationships
— Family-based interventions in general population
Prenatal alcohol exposure
— Prenatal alcohol exposure has been associated with offspring drinking in young adulthood,
with substance disorders,
with conduct problems even after propensity score adjustment etc.
— BUT other studies including adoption studies did not found as strong associations
Heritability & abuse
Heritability
— Increases in environments with greater alcohol availability and exposure
— Appears to be stronger for problematic substance use than for initiation of substance use and is particularly strong for cigarette smoking
Sher proposed a useful framework that organizes large number of familial and associated risk factors with 3 interrelated biopsychological pathways of transmission:
- Deviance proneness pathway
- Authoritative combines warmth and control (good)
- Substance use effects pathway
Deviance proneness pathway
- Deviance proneness pathway
— Parents with SUDs both genetically transmit predispositions to behavioral “under control” and also provide suboptimal parenting
Authoritative combines warmth and control (good)
Authoritative combines warmth and control (good)
— Stress and negative affect pathway
— Parents with SUDs may genetically transmit predispositions for high negative emotionality and poor emotion regulation and also provide environment that is high in stress and poor in scaffolding the development of appropriate coping
Substance use effects pathway
- Substance use effects pathway
— Focuses on individual differences in sensitivity to effects of particular substances, which create differential vulnerability to the development of SUDs
Parental antisocial personality disorder
Parental antisocial personality disorder
— Antisocial personality disorder (ASPD) has been frequently linked with SUDs
— Parental ASPD predicts adolescent and young adult substance use, even after controlling for parental SUDs etc.
— Antisociality appears to be associated with the density of familial alcoholism
— Co-occurrence of ASPD, alcohol disorders, and/or drug disorders in parents is associated with the worst offspring outcomes
parental mood and anxiety disorders
— …also associated with increased risk of offspring substance abuse
— In a study, children of affectively ill parents were five times more likely to be alcohol dependent
— More related to girl drinking problems than boys
— However, many studies do not differentiate between parental affective and anxiety disorders and SUDs
The effects of family structure: single-parent families, divorce, and parental death
The effects of family structure: single-parent families, divorce, and parental death
— Transition from a two-parent family to a single-parent family had particularly strong effect on adolescent alcohol and marijuana use
— greater risk for substance use
— In single-parent families: greater alcohol use frequency when father has custody compared with when mother has custody
— BUT father custody is uncommon grater alcohol use frequency can be due to selection effects
— Timing of parental divorce:
— More drug and alcohol problems in young-adult offspring whose parents separated before age 16 than in intact families
— No difference between offspring of intact families and offspring whose parents separated after age of 16
reasons for effects of family structure
— Degree to which child experiences stressful changes due to divorce
— Disruption of offspring’s beliefs about predictability of events and the importance of conventional norms may increase social alienation and involvement with substance-using peer groups
— Decreased quality of parenting practices and family relationships
— Presence of nonbiological parent increases family tension and decreases quality of parent-child relationship
— Less parental supervision
— Spend more time outside family more time with substance using peers (more opportunities)
— Study found that peer substance use and peer approval of substance use mediates 78% of the elevation in risk for adolescent substance use problems in single-parent family
— Parental modeling effect
— People who never marry or who are divorced tend to drink more
— Different reasoning: many of the risk factors that appear to lead to youth maladjustment and substance use after divorce may have been present before divorce
Maltreatment & SUD
Maltreatment
— Deficits in children’s ability to regulate emotions, problems in peer relations and difficulties adapting to school higher risk for SUDs
— Early and chronic stress dysregulation in HPA axis higher risk for SUDs
— Many studies found relation between physical abuse, sexual abuse, and neglect and SUDs in females but not on males
FActors influencing SUD
Maltreatment
adolescent self-disclosure
family structure
parental mood and anxiety disorders
Parental antisocial personality disorder
Sibling influences
family disharmony, family disorganization, and low family cohesion/connectedness
Is parent monitoring a parent or child characteristic?
— Parent monitoring has been consistently supported as an influence that reduces adolescent substance use
However, Knowledge acquired through adolescent self-disclosure = much stronger protective factor against adolescent problem behaviors
Mediators and moderatos of the effects of parenting on offspring substance use
deviance proneness models
Stress and negative affect pathways
Attitudes and beliefs as mediators of parenting effects
Substance use-specific parenting practices
Stress and negative affect pathways
Stress and negative affect pathways
— Negative affect models emphasize the role that substance use can play in the alleviation of negative affect
— Studies support the role of negative affect as a mediator between parenting and substance use
— Authoritarian parents increased depression increased substance use
— Both support- and discipline-related parenting effects on problem drinking are mediated by poor emotion regulation, stress, and low self-esteem
deviance proneness models
deviance proneness models
— … view adolescent substance use as part of a broader constellation of deviant behaviors that generally originate from complex and reciprocal interplay among poor parenting, behavioral under control, and involvement with deviant peers
— Research support:
— Protective effects of good parenting on adolescent substance use are mediated by reductions in adolescents’ involvement with deviant peers and reductions in adolescents’ behavior under control
Attitudes and beliefs as mediators of parenting effects
Attitudes and beliefs as mediators of parenting effects
— Protective effects of good parenting on adolescent substance use are mediated by reductions in:
— Adolescents’ positive attitudes about substance use
— Increases in adolescents’ belief in their ability to refrain from substance use
— Reductions in adolescents’ intentions to use substances
— Reductions in adolescents’ favorable perceptions of peers’ substance use
Substance use-specific parenting practices
Substance use-specific parenting practices
— Substance use-specific socialization practices also uniquely predict children’s substance use
— might be useful targets for family-based interventions programs
— The more parents talk with their children about substance use the less likely children are to use substances
— However, other studies found that communication about substances is related to greater substance use or initiation of use in children or that it’s unrelated to substance use
— Might be due to reverse directions effect
sibling influence
— Adolescents’ substance use is related to the substance use of their siblings
— Older siblings affect younger ones
— Moderated by the sibling relationship quality
— Warm and supportive relationship higher risk
— Greater in influence when closer in age
— Mediated by:
— Shared environment (parents, peers)
— Shared social network
— Associations with an alcohol-using peer group:
— Substance use of first sibling predicts peer group of second predicts substance use of second sibling
Ú Genes and parents’ influence is not enough to explain the connection
