Theories of substance use Flashcards
When was the moral model introduced?
During the 18-19th centuries when addiction was viewed as a sin
What is the moral model?
- “morally weak” and addiction was seen as a fault of one’s character
- Users are characterised as ‘misfits’, ‘no-hopers’, or as objects of pity; dealers are routinely described as ‘scum’, ‘vermin’ or ‘an evil menace’.
What occured under the influence of the moral model?
- users were punished with whippings, public beatings, stocks, fines, and public ridicule
- Spiritual direction was also a common treatment.
- Jail sentences: mental hospitals as the jails became full.
What does the Disease Model believe?
- Addiction does not exist on a continuum: it is either present or it isn’t.
- Addicted people cannot control their intake. Once they consume some of the substance (eg one drink) they are powerless to stop themselves/overtaken by almost irresistible cravings when they cannot have it.
- The disease of addiction is irreversible. It cannot be cured and can only be treated by lifelong abstinence.
What is believed by the 12 step model?
- 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.
What are the advantages of the 12 step model?
- drug use becomes a health issue and not just a legal issue
- allows ‘addicted’ people to understand their behaviour
- offers a treatment approach (abstinence) that works for some
- removes some of the shame often felt by people affected by addiction.
What are the disadvantages of the 12 step model?
- removes responsibility from the user
- offers only one course of treatment (abstinence) which is not suitable for all people, particularly young people
- not supported by a large amount of evidence.
What are the 12 steps in the 12 step program?
1 - Admission 2 - Recognition 3 - Submission 4 - Understanding 5 - Confession 6 - Readiness 7 - Humility 8 - Reparation 9 - Apology 10 - Integrity 11 - Mediation 12 - Awakening
Who did the psychodynamic model originate from?
Sigmund feud
What is the psychodynamic model?
- we can link problems to our childhood and how we cope as adults
- substance use may be an unconscious response to difficulties experienced in childhood
What are the psychodynamic model’s assumptions on drug use and addiction?
- Drug use is a symptom of an underlying psychological disorder
- Indicates severe psychopathology
- Psychological problems are the cause of substance abuse, not recognised as a consequence of use
- Addiction is considered a uniform disorder
What is the Freudian theory of the unconscious processes that govern the id, ego and superego and AOD use?
○ Fixated at the “oral” stage
○ Id – drive reduction theory.
○ Ego – “self medication”
What is the personality theory?
- Group of distinct personality characteristics that distinguish alcoholics/drug users from other individuals
- Predisposing factor (‘addictive personality’)
- Independent (personality trait and dependence)
What are personality predictors of drug use?
- Behavioural disinhibition (impulsivity)
- Emotional negativity (negative mood, depressive PD)
- Other personality features (e.g., narcissism)
- Used to enhance sensation and avoid pain
How does current psychodynamic research interpret addiction?
As a self-regulation disorder
- inability to regulate feelings,
- inability to establish sense of self/self-esteem, comforting relationships and control/regulation of behaviour and self-care
What do neuroscientific/biological theories focus on?
- Genetic characteristics
- Reward systems
- Neuro-adaption
What are the genetic characteristics in the neuroscientific/biological theories?
- People may inherit an increased likelihood (vulnerability) of developing dependence on substances.
- Increasing area of interest
- Family/twins studies; Environment versus genetics
What results have been found on the genetic characteristics in the neuroscientific/biological theories?
- No single candidate genes have been discovered that are directly related to drug abuse
- Evidence to suggest a relationship between tobacco smoking and genes involved in dopamine regulation
What are the reward systems in the neuroscientific/biological theories?
Different drugs have different primary actions on the brain, but two major pathways have been implicated as common to most drugs
○ the dopamine reward system
○ endogenous opioid system
What is Neuro-adaptation in the neuroscientific/biological theories?
- When drugs are repeatedly administered, changes occur in the chemistry of the brain to oppose the drug’s effects.
- When this drug use is discontinued, the adaptations are no longer opposed; the brain’s homeostasis is disrupted
- Argues that tolerance to the effects of a drug and withdrawal when drug use stops are both the result of neuroadaptation
What is the social learning model?
- the idea that dependence is not only chemical but also behavioural and social in nature.
- use is learned and is functional
- interaction between the environment, the individual and the drug as a way to understand the complexity of the drug experience.
What does the social learning model believe about dependence?
- Dependence is a learned behaviour that results from conditioning, modelling and thinking about the substance.
- Dependence exists in degrees. The greater the dependence then the greater the negative feelings experienced in the absence of the activity.
- Dependence is a normal facet of human behaviour.
What three factors influence people under the social learning theory?
personal factors
environment
behaviour
What do behavioural theories consider?
observable/measurable behaviour
What are the 4 main types of conditioning in behavioural theories?
○ Classical conditioning
○ Operant conditioning
○ Modelling
○ Tension reduction
What is the Classical conditioning model?
Idea that sights, smells and sounds are associated with drug use and elicit physiological and psychological responses lead to drug seaking
- Conditioned stimuli (CS) – cues and triggers
- Conditioned response (CR) – physiological and psychological responses
(pavlov’s dog)
What is the Operant conditioning model?
• Focuses on reinforcing properties of drugs, and the likelihood of people repeating immediately pleasurable experiences (and avoiding unpleasurable experiences)
What are the 3 main types of reinforcement in Operant conditioning models?
- Positive reinforcement (eg. drugs can cause pleasurable sensations)
- Negative reinforcement (eg use to remove aversive experiences)
- Punishment
What is Modelling in behavioural theories?
- People learn favourable attitudes and expectation about drinking based on how the behaviour is modelled.
- bobo doll experiment
What is the tension reduction theory?
ABC’s
- there is tension in society and the demand to relief tension creating two problems; of eliminating conditions that create tension and of finding a mode to relief tension
- involves Antecedents, Behaviour and Consequences
What are the Antecedents in the tension reduction theory?
triggers; situations, thoughts, feelings
e.g. situation = home alone, thoughts = I wish I had a social life, feelings = sad and anxious
What are the Behaviours of the tension reduction theory?
something the person does
e.g. drinks alcohol
What are the Consequences of the tension reduction theory?
reinforces - outcomes of that maintain the behaviour
e.g. feelings of relief, relax
What is the 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 – core beliefs / schemas
Cognitive-behavioural: thoughts and behaviours are learnt and therefore can be ‘unlearnt’ (CBT)
What is cognitive dissonance or conflicting beliefs?
The 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”
What are the two specific cognitions of the Expectancy Theory (Bandura)?
- Outcome expectancy – beliefs about effects and outcomes of using
- Self-efficacy – belief in one’s own ability to effect change
How are CBT and cognitive/behavioural theories engaging with treatment and relapse prevention?
- Interaction of high risk situations (cues/triggers) with coping response and expectancy (outcome and self-efficacy)
- Aim is to reduce high risk situations and increase alternative coping strategies and self-efficacy
- Emphasis on mindfulness and acceptance strategies to reduce the impact of internal triggers on substance use behaviour
- Transdiagnostic - effectively target key psychological problems commonly comorbid with substance use
What are the Motivational and change theories?
- Increase the client’s awareness of the potential problems caused, consequences experienced, and the risks faced as a result of the behaviour in question
- Motivational interviewing (Miller) - intrinsic motivation is a necessary and sufficient factor to initiate behaviour change
What are the Motivational and change theories upward spiral steps?
precontemplation (no intention to change)
contemplation (aware of problem, no commitment to action)
preparation (intent to act)
action (active modification of behaviour)
maintenance (sustained change, new behaviour replaces old)
relapse (fell back into old behaviour)
- cycle continues around
What is the family and systems theory?
- determinants of behaviour are based on an individuals role within a system.
- Family and other system
- culturally and socially disadvantaged
- model links substance abuse to the conditions of the wider society, importance is placed on interventions on the system rather than the individual.
What are the common elements of the family and systems theory?
○ Boundaries
○ Reciprocal causality
○ Homeostasis
What is the Biopsychosocial model?
an approach to describing and explaining how biological, psychological and social factors combine and interact to influence physical and mental health
