ADDICTION

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ADDICTION

• How do people become addicted?

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What is Addiction?

• A behavioral syndrome where drug procurement and
  use seem to dominate the individuals motivation
  and where the normal constraints on the
  individuals behavior are generally ineffective
  (e.g., self-perceived loss of control).

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The Road to Addiction

• Experimental/Circumstantial Drug Use ?
• Casual Drug Use ? Intensive Drug Use?
• Compulsive Drug Use ? ADDICTION

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Pathway to AddictionProdromal Phase

• Developing increased tolerance
• First blackout or loss of time to substance use
• Sneaking drugs or drinks
• Preoccupation with drug use
• Gulping drinks or hurried taking of drugs
• Avoiding references to substance use

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Pathway to AddictionCrucial Phase

• Loss of Control of Substance
• Denial and minimization
• Confrontation by others
• Behavior loss of control
• Guilt and Remorse

• Periodic abstinance change in use patterns
• Losses
• Medical and Psychological interventions
• Alienation and resentment
• More frequent use

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Pathway to AddictionChronic Phase

• Continued use of substance for longer periods
• Indefinable fears and vague spiritual desires
• Impaired judgment and irrational thinking
• Tremors, malnutrition, overdoses, decreased
  tolerance, and/or other physiological problems
• Obsessive use until recovery or death

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Danger Signs

• Preoccupation
• Increased Tolerance
• Rapid Intake
• Using Alone

• Use as Panacea
• Protecting Supply
• Unpremeditated Use
• Blackouts

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Major areas of functioning

• Job or School
• Relationships with family
• Social relationships
• Legal problems
• Financial Problems
• Medical Problems

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Addicts

• For the addict, the chemical comes first.
• The addict seems powerless to change on their
  own.
• The addicted are involved in a vicious cycle
  which manifests behaviors that produce shame and
  guilt that perpetuate more addicted behavior.

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Levels of Substance Use

• Substance Use
• Substance Misuse
• Substance Intoxication
• Substance Abuse
• Substance Dependence

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Substance Misuse

• Prescription or nonprescription drug used
  inappropriately. (Instrumental v. Recreational)
• Substances entering the body that may or may not
  produce a manageable degree of psychoactive
  reactions.
• Key components are that effects are temporary,
  reversible, and do not produce significant
  impairment or behavioral change.

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Substance Intoxication

• The development of a substance-specific syndrome
  due to recent ingestion of a substance.
• Effects may be temporary and reversible.
• Clinically significant maladaptive behavioral or
  psychological changes that are due to the effect
  of the substance on the central nervous system
  including belligerence, mood lability, cognitive
  impairment, impaired judgment, developed during
  or shortly after use of the substance

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Substance Abuse

• Failure to Fulfill Major Roles
• Use in Hazardous Situations
• Recurrent Legal Problems
• Use Despite Social Problems
• Never Met Criteria for Dependence

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Substance Dependence

• Tolerance
• Withdrawal
• Larger Amounts or Longer Periods
• Desire or Unsuccessful Efforts to Cut-Down
• Time Spent Obtaining, Using or Recovering
• Decreases in Social, Work, or Recreational
  Activities
• Continued Use Despite Problems

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Tolerance and Withdrawal

• Tolerance
• The failure of a past dose of a drug to produce
  the desired effect and the need for progressively
  larger quantities of the drug.
• Withdrawal
• A substance specific physiological reaction to
  cessation of a drug. It is unpleasant and causes
  psychological or physical distress.
• Distress or Impairment in Function

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DSM-IV Classifications

• Substance Induced Disorders
• Substance Intoxication
• Substance Withdrawal
• Substance Induced Delerium, Dementia, Persisting
  Anmestic, Mood, Anxiety, Psychotic
• Substance Use Disorders
• Substance Abuse
• Substance Dependence

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Models of Addiction

• Moral Model
• Disease Model
• Genetic Model
• Systems Theory

• Behavioral Theories
• Sociocultural Model
• Neuropsychological Models
• Biopsychosocial Model

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Moral Model
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Moral Model

• Alcoholic/addict seen as a result of moral or
  individual weakness.
• Character flaw willpower
• Punishment rather than treatment is common
  approach
• Cure results from character development.
• Willpower, Religious Sources
• Rarely adhered to by professionals today

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Disease/Medical Model
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Disease Model

• In the 1950s the World Health Organization (WHO)
  and American Medical Association (AMA) classified
  drug addiction as a disease.
• Disease
• A condition of the body that impairs the
  performance of a vital function.

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Disease Model

• Progressive disease with symptoms
• Loss of control
• Death
• Illness is physical, mental and spiritual
• AA closely tied to this theory

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Benefits of Disease Model

• Relieves the guilt and shame felt by addicts for
  having the disease may make them more responsive
  to treatment
• Viewing addiction as a disease opens it to
  scientific research
• Addict is not seen as a sinner or criminal.

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Problems with the Disease Model

• Addicts may deny responsibility for treatment.
• How exactly does someone catch this disease?

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Family/Systems Theory
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Systems Theory

• Focus on family
• Considered a Family Disease
• Relies on codependence
• Al-Anon and CODA are based on this theory

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Systems Theory

• Person identified as ill (addicted) acts out
  anxiety for the family.
• As family tensions rise, symptoms become worse.
• As addict recovers, dysfunction occurs in other
  family members.
• Dysfunction is worse in highly fused, rigid
  family systems.

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Stages of Addiction in Family Systems Theory

• Denial (Hide problem, Excuses, Isolation)
• Home Treatment (Nagging, threatening, hiding
  substances, controlling other family members
  behavior, role shifting)
• Chaos (Not hiding problem, conflicts with others,
  threaten withdrawal of support)
• Control (Others attempt to control addicts
  behavior, assume responsibility for addict,
  separation, divorce, etc.

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Genetic Theories
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Genetic Model

• Strong gender-linked inheritability
• Strong patterns of generational drinking
• Aldehyde dehydrogenase differences among
  ethnicities.
• No single chemical dependence gene isolated at
  this time.

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Intergenerational Studies

• Useful in detecting patterns of occurrence in
  substance abuse
• Give a broad overview of the condition,
  indicating trends and frequencies of substance
  abuse
• Ineffective in discerning the effects of genetics
  versus environment

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Behavioral Theories
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Behavioral Theories

• Alcohol/Drug used to reduce tension
• Anticipation of predictable and regular actions
• Biobehavioral theories biological mixed with
  behavioral
• Pavlovs Classical conditioning theory

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Behavioral Theories

• Treatment goals for changing the behavior are
  easily formulated.
• Biological aspects of addiction are not addressed
  in many of the behavioral theories
• Genetic predispositions to addiction are largely
  ignored.

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Neuropsychological Evidence
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Mesolimbic Dopaminergic SystemThe Reward
Pathway

• Hunger, thirst, sexual drive, and nurturing act
  directly on the primitive brain stem and limbic
  (emotions) structures, which can override the
  cerebral cortex in motivating and controlling
  behavior.

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THE REWARD PATHWAY
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Prefrontal Cortex
Ventral Tegmental Area
Nucleus Accumbens
NIDA
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DOPAMINE TRANSMISSION
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Drug Craving

• Natural State of the Brain is Drug Free
• New Normal Brain is Drug Present
• Return to Homeostasis
• Lasting Change in Neurotransmitters
• Dopamine
• Serotonin
• Lasting Change in Neurotransmission

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Addiction vs Dependence
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Sociocultural Theories
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Sociocultural Theories

• Emphasis on social and cultural factors
• Socioeconomic influences
• Socially shared beliefs and behaviors
• Social norms
• External locus of control

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Sociocultural Theories

• Substance abusers are viewed within the larger
  context of their environment.
• The importance of social pressure is recognized.
• The use of drugs is viewed within the cultural
  context of the individual using them.

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Biopsychosocial Theory
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Biopsychosocial Theory

• Integrated Approach
• Many factors in initiation and maintenance of an
  addictive disorder.
• Multiple pathways to addiction
• neurophysiological family
• genetics learning

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Biopsychosocial Theory

• All contributing factors for the development of
  substance abuse are considered.
• Treatment can be multifaceted, dealing with many
  interacting underlying issues.
• May be too encompassing and too broad to
  precisely describe the origins of substance abuse.