Week 7 - Theories

Question 1

What constitutes psychological theory?

Answer 1

• It describes a behaviour
• it makes predications about future behaviours
• It must have evidence to support the idea
• It must be testable

Question 2

Why are theories important?

Answer 2

 Explains why a drug is more/less addictive:
- in one society than another
- for one individual and not another
- for the same individual at one time and not another
 Make sense of similar behaviour (e.g., compulsive)
 Explains cycle of increasing dysfunctional involvement with drugs
 Must be faithful to the lived human experience

Question 3

What is the Moral model

Answer 3

 The ‘original’ model of addiction
- Temperance movement early –mid 1800;s
 Addiction was viewed as a sin.
- “morally weak”
- 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’.
 Punishment

Question 4

According to the moral model, people who struggle
with substance use..

Answer 4

1. make poor choices
2. lack willpower
3. unwilling to change their own lives
    Common theme is about choice. Although substance use begins as a choice, but a result of addiction is a lack of control

Question 5

Concerns of the moral model

Answer 5

 A person whose drug use is problematic, in most cases, have no difficulty in finding supporting evidence to confirm this view.
- Stigmatisation
- Reluctance to reach out for help
- Decreased self-esteem
 Reinforces the tendency toward self-blame, self hatred and a sense of extreme powerlessness.
 Work against the prospect of genuine change diminishing motivation; avoid taking responsibility.

Question 6

Spiritual Model

Answer 6

 It is not poor choices or a lack of willpower that causes addiction, but rather a disconnection from God or another Higher Power.
 In order to overcome addiction, the individual must first establish a deeper connection with themselves, other people, and the broader world around them.
 At the core of the spiritual model is the assumption that
people do not overcome addiction on their own. Rather, it is a
variety of factors—a Higher Power, a community of other
people in recovery, and a spiritual awakening, that allow people to overcome addiction

Question 7

Disease model key points

Answer 7

 Assumes that the origins of addiction lie within the
individual.
 Medical viewpoint - addiction is a disease or an illness that a person has.
 Addiction - illness that results from an impairment of healthy neurochemical or behavioral processes

Question 8

Disease model beliefs

Answer 8

 Addiction does not exist on a continuum – present or not
 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.

Question 9

12 step models

Answer 9

 AA, NA, Al-Anon
 Dependence as a “spiritual disease” and “lack of control”

Main premises
 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.

Question 10

The 12 step program

Answer 10

Admission
recognition
submission
understanding
confession
readiness
humility
reparation
apology
integrity
meditation
awakening

Question 10

Advantages of 12 step program

Answer 10

 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

Question 11

Disadvantages of 12 step program

Answer 11

 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.
 Treatment outcomes from 12 step programs associated with greater friends, spiritual connection, finding meaning in life

Question 12

3. Neuroscientific / biological theories

Answer 12

 Focus is on the effects of drugs on the brain.
 Genetic characteristics
 Reward systems
 Neuro-adaption

Question 13

Genetic characteristics

Answer 13

 People may inherit an increased likelihood (vulnerability) of developing dependence on substances.
 Increasing area of interest - no single candidate genes have been discovered directly related to addiction but may involve multiple
genes or incomplete expression of several major genes

Examples:
 Evidence suggest a relationship between tobacco-smoking and genes
involved in dopamine regulation (Sabol et al., 1999).
 Brain’s cannabinoid system - variants of the CNRl gene were associated with cannabis, cocaine, and heroin dependence (Comings et al., 1997).
 Family/twins studies
 Environmental factors

Question 14

Reward systems

Answer 14

 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

Question 15

Neuro-adaption

Answer 15

 Refers to changes in the brain that occur to oppose a
drug’s acute actions after repeated drug administration.
 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
 Essentially, this hypothesis argues that tolerance to the effects of a drug and withdrawal when drug use stops are both the result of neuroadaptation
 As a result, use continues in an attempt to avoid the symptoms that follow if drug use stops

Question 16

4. Psychoanalytical theories

Answer 16

 Psychodynamic theory originated with
Sigmund Freud and is still used today
 The basic philosophy is that we can link problems to our childhood and how we
cope (or don’t cope) as adults.
-Substance use/misuse may be an unconscious response to some of the difficulties individuals may have experienced in childhood
 Basis of many counselling approaches which aim to gain insight into an individual’s unconscious motivations and try to enhance their self-image.
 Nature and nurture
 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

Question 17

Examples

Answer 17

1. Unconscious processes that govern the id, ego, & superego (Freudian)
    Fixated at the “oral” stage
    Id – drive reduction theory.
    Ego – “self medication”
2. Attachment styles (Bowlby)
    Secure
    Ambivalent-avoidant insecure
    Anxious-avoidant insecure
    Disorganised-insecure

Question 18

Another example

Answer 18

3. Personality theory
    Group of distinct personality characteristics that distinguish alcoholics/drug users from other individuals
    Predisposing factor (‘addictive personality’)
    Limited evidence of ‘addictive personality’ per se
    Characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction
    Personality predictors of drug use
    Behavioural disinhibition (impulsivity)
    Emotional negativity (negative mood, depressive PD)
    Sensation seeking
    Non-conformity
    Social isolation and tolerance for deviance
    Avoidance

 Current psychodynamic views addiction more as a self regulation disorder:
 inability to recognise and regulate feelings;
 inability to establish and maintain a coherent, comfortable sense of self and self esteem
 inability to establish and maintain adequate, comforting, and comfortable relationships;
 inability to establish and maintain adequate
control/regulation of behaviour, especially self-care
 Treatment via the therapeutic relationship and specific psychoanalytic techniques

Question 19

5. Social learning models

Answer 19

 Russell (1976) introduced the idea that dependence is not only chemical but also behavioural and social in nature. It is based more on the user’s thoughts about the substance, and what it is like to be ‘under the influence’ of the drug itself.

 Two central notions that substance use is:
 Learned, and
 Is functional.

 Focus on the interaction between the environment, the individual and the drug as a way to understand the
complexity of the drug experience.

Question 20

Key points of social learning theory

Answer 20

• Anyone who engages in an activity that they find pleasurable is at risk of developing dependence on that activity.
• Dependence is a learned behaviour - 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. It only becomes a problem when the individual experiences a number of
  negative consequences as a result of their behaviour, but
  continues to do it anyway.
• A sense of compulsion, of wanting to engage in a behaviour (such as drug use), but knowing that one really shouldn’t, is the hallmark of addictive behaviour.
• Behaviours are only terminated when the individual makes the decision that the costs of continued use are vastly greater than the benefits

Question 21

Social learning theory

Answer 21

• Social learning interventions focus on altering the client’s
  relationship with their environment.

personal factors <—> environment <–> behaviour (all connected)

• Example: Adolescents who view substance use in a positive light, whose peers use drugs, and whose parents and peers have attitudes that condone substance use are more likely to use substances

Question 22

Behavioural theories

Answer 22

 Only considers observable/measurable behaviour
 Behaviour is a consequence of learning

 Four main types of conditioning
Classical conditioning
Operant conditioning
Modelling
Tension reduction

Question 23

Classical conditioning models

Answer 23

 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

Question 24

Operant conditioning models

Answer 24

 Focuses on reinforcing properties of drugs, and the likelihood of people repeating immediately pleasurable experiences (and avoiding unpleasurable experiences)

Three main reinforcement types:
1. Positive reinforcement (e.g., drugs can cause
pleasurable sensations)
2. Negative reinforcement (e.g., use to remove aversive experiences)
3. Punishment

Question 25

Modelling

Answer 25

 People learn favourable attitudes and expectation about drinking based on how the behaviour is modelled.
 Increases the likelihood of pleasant experiences learned from others
 Maintenance associated with past associations with
drug-taking environments/situations

Question 26

Tension reduction theory

Answer 26

Tension in society
Demands relief
–> problem of elimination of reduction of conditions that create tension
–> problem of finding a mode for relief of tension

Question 27

A – Antecedents

Answer 27

Triggers
*Situations
*Thoughts
*Feelings

Question 28

B – Behaviour

Answer 28

Something the person
does

Question 29

C- Consequences

Answer 29

• Reinforcers – outcomes that maintain the behaviour
• Payoffs

Question 30

Cognitive & cognitive-behavioural theory

Answer 30

 Cognitive model
- Core beliefs (schemas)
 Expectancy theory

Question 31

Cognitive model

Answer 31

• 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

Answer 32

 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)

Question 33

Third wave psychotherapies, contextual CBTs

Answer 33

 Acceptance and Commitment Therapy
 Dialectical Behaviour Therapy
 Mindfulness-based relapse prevention

Question 34

Key difference to traditional CBT:

Answer 34

 emphasis on mindfulness and acceptance strategies to reduce the impact of internal triggers on substance use behaviour (e.g., altering the context and function so cravings, distress, or thoughts of using are less likely to lead to substance use).
 Taking a broad, functional approach to treatment, emphasising motivation and values-based strategies
 Transdiagnostic effectively target key psychological problems
commonly comorbid with substance use including depression, anxiety and self-stigma

Question 35

Expectancy theory (Bandura)

Answer 35

 Addictive behaviours chosen over other behaviours due to our expectancies.
 Two specific cognitions:
- Outcome expectancy – beliefs about effects and
outcomes of using
- Self efficacy – belief in ones own ability to effect
change

Question 36

6. Motivation and Change theories

Answer 36

 ‘Transtheoretical’
 Increase the client’s awareness of the potential problems caused, consequences experienced, and the risks faced as a result of the behaviour in question
 Clients do not necessarily enter treatment committed to action and making changes
 Motivational interviewing (Miller) - intrinsic motivation is a necessary and sufficient factor to initiate behaviour change

Question 37

The transtheoretical approach

Answer 37

precontemplation - no intention of changing behaviour

contemplation - aware a problem exists no commitment to action

preparation - intent upon taking action

action - action mortification of behaviour

maintenance - sustained change

relapse - fall back into old pattern of behaviour

Question 38

7. Family & systems theory; socio-cultural

Answer 38

 Determinants of behaviour are based on an individuals
role within a system.
 Focuses on society as whole and not just on individuals
- Family and other systems (e.g., peers) have role in initiating and maintaining substance use
- The type of society in which people live has an impact on their drug use. In particular, this model makes links between inequality
and drug use. It suggests that people who belong to groups who are culturally and socially disadvantaged are more likely to experience substance abuse problems.
- Because this model links substance abuse to the conditions of the wider society, importance is placed on interventions on the system rather than the individual
 Many differing theories. Shared common elements:
Boundaries
Reciprocal causality
Homeostasis
 Family based interventions eg ‘Stress coping’ perspective
 Importance of placing emphasis on interventions for the system e.g., family therapy/involvement of significant others, addressing stigma, poverty, poor housing, disadvantage etc

Question 39

Biopsychosocial model

Answer 39

• Proposes that drug use is influenced by a combination of biological, psychological, and social factors.

biological –> psychological –> social

Question 40

What is biology in the Biopsychosocial model

Answer 40

Physical health
Genetic vunrabilities
Drug effects

Question 41

What is social in the Biopsychosocial model

Answer 41

Peers
Family Circumstances
Family Relationships

Question 42

What is psychological in the Biopsychosocial model

Answer 42

Physical Health
Coping Skills
Social Skills
Family Relationships
Self-Esteem
Mental