Topic 2: Theories of addiction and substance use treatment Flashcards
Why do only some people become addicted?
Etiology of drug addiction is complex, and Ruiz and Strain (2014) note that each individual has a unique pattern of becoming addicted to a substance. Thus not all individuals will react to a particular drug, behaviour, or substance in the same way.
Certain factors constitute significant vulnerabilities for addition, including genetic and neurobiological influences, drug properties, psychological properties, and sociodemographic variables. In the following sections we will consider some of the key influential theories and models of addiction in an attempt to answer the question: Why do only some people become addicted?
what does the individual model of addiction suggest?
Key cause Individual is responsible:
- personal responsibility
- spiritual deficits
- irreversible abnormality of individual
- lack of knowledge/motivation
- personality traits
- classical/operant conditioning
- expectancies, beliefs
- genetics, brain
-The early moral models of addiction argue that substance use problems are wilful violations of societal rules and norms. Substance users are perceived as “bad”, deviant people who have broken the rules of society, making them not like ‘us’.
what are some individual (key cause) models of addiction and what do they suggest?
Key cause Individual is responsible:
-Moral model, personal responsibility
The early moral models of addiction argue that substance use problems are wilful violations of societal rules and norms. Substance users are perceived as “bad”, deviant people who have broken the rules of society, making them not like ‘us’.
spiritual model:
-spiritual deficits, arising from the Protestant movement in America, considered substance use as a sin and problematic substance use as reflecting a deviation from one’s spiritual path.
dispositional disease model, –irreversible abnormality of individual, individuals who use drugs become ‘addicted’ to the substance, which implies a pathological dependency and loss of control and reason; ‘addiction’ then is seen as an illness or disease of the body.
Other models attribute the cause of problematic substance use and addiction to psychological factors, including learning, personality and cognitions.
- lack of knowledge/motivation
- personality traits ( While there is little evidence for an addictive personality, an association between the personality trait impulsivity and substance use has been found. Impulsivity includes the two dimensions rash impulsivity, the tendency to engage in spontaneous behaviour without consideration of consequences, and reward sensitivity or a heightened sensitivity to rewarding stimuli in the environment. Longitudinal studies have reported an association between childhood impulsivity and an increased likelihood of problematic substance use in adulthood (Tarter et al., 2004).
- classical/operant conditioning
- expectancies, beliefs (Expectancies are the if-then associations in long-term memory which provide information about the probable outcomes of behaviour. Evidence indicates expectancies about drinking outcomes are related to alcohol use and predict patterns of alcohol use prospectively over as long as nine years (e.g., Newcomb et al., 1988). )
Biological models of addiction emphasize genetic and physiological processes in the development of substance use and behavioral addictions.
-genetics, brain
What is they drug (key cause) model of addiction?
The temperance model assumes the cause of addiction is the substance itself.
According to the model, addiction is caused by exposure to the addictive substances or behaviour meaning that the substance or behaviour is considered dangerous to society and must be eliminated. An underlying premise of this model is that the society has an obligation to the community to protect them from the dangers of addiction, often leading to strategies similar to the alcohol prohibition period in the United States between 1919 and 1933. Alternatively, prevention might be achieved by reducing the availability of dangerous substances and activities. The heavy taxation of cigarettes is one example.
What are some environmental (key cause) models of addiction?
- social learning (peers, exposure to substances and substance using role models, the media)
- Sociocultural (cultural norms)
- general systems (family dysfunction, poverty)
- public health and policy ( environment, deprivation)
What are some environmental (key cause) models of addiction?
- social learning (peers, exposure to substances and substance using role models, the media)
- Sociocultural (cultural norms)
- general systems (family dysfunction, poverty)
- public health and policy ( environment, deprivation)
what influence does genetics have on addiction?
-in a twin study they found that 50-60% of the variance of becoming an alcoholic was due to genetics.
-Children of alcoholics have been found to have a four-to-five fold increased risk of developing an alcohol use disorder.
The genetic influence of nicotine appears even greater than that of alcohol, with studies suggesting around 50% of initiation of smoking behaviour and 70% of ongoing smoking behaviour are attributable to one’s genes (Ruiz & Strain, 2014).
important to note that environment and genetics interact. passive correlation, for example a person venerable to addiction genetically might also be around the substance and possible parental modelling etc will influence the behaviour.
-active correlation
individual seeks the environment that are correlated with their genetic propensities. Seek out
evoke reactions from others that correlate with the predispositions (recipical determanism.).
In addition to the influence on developing a substance use addiction, genetics can influence such things as subjective effects of a drug, the toxicity of a substance, development of tolerance, withdrawal and craving associated with a substance (WHO, 2004).
what is the reward pathway in the brain called? and what are the main structures? and why is it necessary in terms of survival?
The mesolimbic dopamine pathway is the brain’s reward pathway. the core structures of the reward pathway are located in the mesolimbic system connected by the median forebrain bundle (MFB): notably the nucleus accumbens, the ventral tegmental area (VTA), and the prefrontal cortex. When the reward pathway is stimulated, the neurotransmitter dopamine is released from the VTA to other structures in the reward pathway.
In evolutionary terms, the brain’s reward pathway developed to ensure survival of the species by rewarding engagement in eating and sexual behaviour. Psychoactive drugs similarly stimulate the reward system of the brain leading to the subjective feeling of pleasure, reinforcement of drug taking behaviours and addiction.
Dopamine is important for many functions, including mood and emotion, thought patterns, sleep, and control of body temperature. Use of psychoactive drugs increase the level of dopamine in the reward pathway and is the key neurotransmitter implicated in drug addiction.
When psychoactive drugs are used, the reward pathway is overstimulated and dopamine is released leading to reinforcement of drug using behaviour. Addiction to the drug occurs with repeated drug use (Hart & Ksir, 2013).
what role does dopamine play in influencing addiction?
When a drug is initially used, the reward pathway is flooded with dopamine, and is associated with the characteristic euphoric or ‘high’ feeling associated with drug use. This reaction causes a reinforcing pattern that leads an individual to repeat their drug use. With continued drug use over time, the brain adapts to the elevated dopamine levels by producing less dopamine, and reducing the number and activity of dopamine receptors within the reward pathway. Thus repeated drug use leads to alterations in brain functioning, called neuroadaptation. The brain comes to rely on the drug to achieve balance and homeostasis. Over time, a drug user develops a physiological tolerance to the drug requiring increasingly higher doses to achieve the same euphoric ‘high’ they experienced during the initial stages of drug use.
Once tolerance to a drug has developed, uncomfortable withdrawal effects are experienced when drug use is stopped and the effects of the drug wear off. The withdrawal syndrome is due to a lack of homeostasis and is a consequence of the brain’s neuroadaptation to the drug. The symptoms of the withdrawal syndrome are always the opposite of the effects of the drug. One easy way to get rid of the withdrawal symptoms is to use the drug again.
what role does dopamine play in influencing addiction?
When a drug is initially used, the reward pathway is flooded with dopamine, and is associated with the characteristic euphoric or ‘high’ feeling associated with drug use. This reaction causes a reinforcing pattern that leads an individual to repeat their drug use. With continued drug use over time, the brain adapts to the elevated dopamine levels by producing less dopamine, and reducing the number and activity of dopamine receptors within the reward pathway. Thus repeated drug use leads to alterations in brain functioning, called neuroadaptation. The brain comes to rely on the drug to achieve balance and homeostasis. Over time, a drug user develops a physiological tolerance to the drug requiring increasingly higher doses to achieve the same euphoric ‘high’ they experienced during the initial stages of drug use.
Once tolerance to a drug has developed, uncomfortable withdrawal effects are experienced when drug use is stopped and the effects of the drug wear off. The withdrawal syndrome is due to a lack of homeostasis and is a consequence of the brain’s neuroadaptation to the drug. The symptoms of the withdrawal syndrome are always the opposite of the effects of the drug. One easy way to get rid of the withdrawal symptoms is to use the drug again.
What other chemical systems can influence addiction?
A number of different chemical neurotransmitters are implicated in substance use and addiction, including dopamine, serotonin, norepinephrine, cannabinoids, glutamate, and gamma-aminobutyric acid (GABA). Of these neurotransmitters, dopamine is associated with the reinforcing effects of all psychoactive drugs.
What other chemical systems can influence addiction?
A number of different chemical neurotransmitters are implicated in substance use and addiction, including dopamine, serotonin, norepinephrine, cannabinoids, glutamate, and gamma-aminobutyric acid (GABA). Of these neurotransmitters, dopamine is associated with the reinforcing effects of all psychoactive drugs.
Drug abuse alters the structure and function of the reward system. Thus, drugs don’t only get you high, they also skew normal motivational systems. In particular, the memory of the positive benefits of a drug high — the emotional benefits — provide a strong incentive to repeat that experience.
what are the motivational models of alcohol use and what do they involve?
Motives to use alcohol represent the final step in the decision to drink or not to drink alcohol. Research shows that these motives are more closely associated with the decision to use alcohol and develop alcohol-related problems than the mental states which underlie them, for example depressive states or social anxiety.
Each of these share common features, including an acknowledgement that individuals drink alcohol to obtain desired consequences, and that the motivational factors that contribute to alcohol use are associated with fundamentally different behaviours
Figure 2: Cox and Klinger (1988) Model of Alcohol’s Instrumental Effects
Cox and Klinger’s (1988) early motivational model proposes that the decision to use alcohol is made when the expected positive consequences of drinking exceed the expected benefits of not using alcohol (Cox & Klinger, 1988). The decision to drink alcohol is, therefore, represented as a process of considering several factors related to:
Historical factors, such as reactivity to alcohol, personality characteristics, external influences, and previous drinking experiences
Current factors, such as incentives and situational influences
Expected effects, including direct chemical and indirect instrumental effects.
According to the model, alcohol dependency or ‘addiction’ occurs when the factors that support the decision to consume alcohol significantly exceed the factors that promote the decision not to drink. As such, problem drinking is not conceptualised as a distinct category, rather it is thought to fall along a continuum which also includes ‘safe’ or low risk drinking patterns.
The expected effects of alcohol use involves two processes. The first is the direct chemical effects alcohol has on one’s emotions. Cox and Klinger (1988) note that the true effects of these are often smaller than the individual’s expectations. The second process is the indirect, or instrumental, effects that result from the decision to use alcohol. Alcohol use may assist or interfere with the ability to achieve other goals which may in turn impact an individual’s mood. For example, an individual might choose to consume alcohol as a consequence of peer pressure. This choice has the potential to result in increased peer acceptance which may improve short term mood.
Cooper’s (1994) four-factor model of drinking motives
internal source positive reinforcement -enhancement (enhance mood or wellbeing) -negative reinforcement -coping (reduce or regulate negative emotions)
External source positive reinforcement -social (obtain positive social reward) -negative reinforcement -conformity (avoid social censure or rejection)
Cooper (1994) -conformity (negative reinforcement) -coping (negative) -social (positive) -enhancement (positive) investigated the relationships between motives and alcohol-related outcomes, and confirmed that different drinking motives are related to varied consequences. Research findings suggest that using alcohol to obtain positive social rewards or to enhance one’s mood or wellbeing may be ‘safer’ and less likely to result in alcohol-related problems, compared to alcohol use motivated by a desire to regulate negative emotions (cope) or avoid social rejection (conform) (Cooper, 1994). However, as we discussed in Topic 1, high and frequent consumption of alcohol is related to a range of other negative consequences. Therefore, while a stronger identification with positive rather than negative reinforcement drinking motives is less likely to be associated with alcohol dependence, it cannot be considered ‘safe’.
what are the motivations of drug use and what are the motivational models of drug use?
Pleasure or reward: activation of the reward centre motivates users to continue using the substance, often in spite of negative consequences.
Relief of physiological or psychological distress: some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.
Improvement (or perceived improvement) in abilities: some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids.
Curiosity: in this respect adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviours to impress their friends and express their independence from parental and social rules.
Bozarth’s drug addiction model proposes that drug users move through four stages before becoming addicted to a substance (see Figure 4 below). In order for casual drug use to progress to addiction, motivational risk factors must be present, including aggressive behaviour in childhood, lack of parental supervision, poor social skills, drug experimentation, availability of drugs at school, or community poverty (NIA, 2015).
This model
experimental drug use or circumstantial drug use = casual drug use =intensive drug use =compulsive drug use = addiction.
what are the two models of gambling and how do they slightly differ?
two motivational models have been derived: the monetary motive mediation model, and the parallel model, both of which are very similar, and outline major motives in predicting gambling severity (see Figure 5 below). The monetary motive mediation model hypothesises that amusement, excitement, and avoidance motives influence gambling severity through the mediation of monetary value. The parallel model hypothesises that socialisation, amusement, excitement, and avoidance motives influence gambling severity.
