Ksir, C., Hart, C., Ray,O. Drugs, Society and Human Behavior, Twelfth Edition. McGraw Hill Publisher
Read Chapter 2 of the text, note the definitions and the major theories about how drug use leads to drug abuse/addiction.
1-What is your favorite theory(s) of Addiction?
2-Why do people become addicted to alcohol, tobacco and other drugs (ATOD)?
3-Write a definition of addiction/dependency:
4-Nature of addiction/dependency – etiology: what happens to a person who is addicted/dependent on ATOD (See also chapter 1 “Drug Dependence” and “Stages of Drug Dependence”; Chapter 2 “The vicious Cycle of Drug Addiction)
5-Bio-Psycho-Social Model: write your favorite explanations of why someone might become addicted to AOD, based on specific theories in each of the following categories
Biological causes/factors of addiction/dependency
Psychological causes/factors of addiction/dependency
The Biopsychosocial Approach
The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel and John Romano. While traditional biomedical models of clinical medicine focus on pathophysiology and other biological approaches to disease, the biopsychosocial approach in our training programs emphasize the importance of understanding human health and illness in their fullest contexts. The biopsychosocial approach systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.
• Biological, psychological, and social factors exist along a continuum of natural systems, as depicted in the list here.
• Systematic consideration of psychological and social factors requires application of relevant social sciences, just as consideration of biological factors requires application of relevant natural sciences. Therefore, both the natural and social sciences are ‘basic’ to medical practice. In other words, psychological and social factors are not merely epiphenomena: they can be understood in scientific ways at their own levels as well as in regard to their biological correlates.
• Humanistic qualities are highly valued complements to the biopsychosocial approach, which involves the application of the scientific method to diverse biological, psychological, and social phenomena as related to human health.
• While the biomedical approach takes the reductionistic view that all phenomena are best understood at the lowest level of natural systems (e.g., cellular or molecular), the biopsychosocial approach recognizes that different clinical scenarios may be most usefully understood scientifically at several levels of the natural systems continuum.
To apply the biopsychosocial approach to clinical practice, the clinician should:
• Recognize that relationships are central to providing health care
• Use self-awareness as a diagnostic and therapeutic tool
• Elicit the patient’s history in the context of life circumstances
• Decide which aspects of biological, psychological, and social domains are most important to understanding and promoting the patient’s health
• Provide multidimensional treatment
The Biopsychosocial Approach
Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136.
Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544.
Frankel RM, Quill TE, McDaniel SH (Eds.): The Biopsychosocial Approach: Past, Present, Future.University of Rochester Press, Rochester, NY, 2003.
Borrell-Carrió F, Suchman AL, Epstein RM: The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med 2004;2:576-582.
Cohen J, Brown Clark S: John Romano and George Engel: Their Lives and Work.University of Rochester Press, Rochester, NY, and Boydell and Brewer Limited, Suffolk UK, 2010.
Explaining Drug Use
Basic Reasons People Take Drugs
- Searching for pleasure
- Relieve pain, stress, tension, or depression
- Peer pressure
- Enhance religious or mystical experiences
- Enhance social experiences
- Enhance work performance, (i.e. amphetamine-types of drugs and cocaine)
- Drugs (primarily performance-enhancing drugs) can be used to improve athletic performance
- Relieve pain or symptoms of illness
Can you think of any additional reasons not listed above?
Use- Abuse- Dependency
- Use = no problems
- Abuse = problems
- Addiction/ Dependency = Loss of Control
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Nature of Addiction
Should addiction be considered:
- A bad habit?
- A failure of healthy choices?
- A failure of morality?
- A symptom of other problems?
- A chronic disease?
- The term addiction is derived from the Latin verb addicere, which refers to the process of binding to things. Today, the word largely refers to a chronic adherence (attachment) to drugs.
- Originally, the World Health Organization (WHO) defined it as “a state of periodic or chronic intoxication detrimental to the individual and society, which is characterized by an overwhelming desire to continue taking the drug and to obtain it by any means” (1964, pp. 9–10).
- Addiction is a complex disease.
Another Definition of Addiction
- The National Institute on Drug Abuse (NIDA) defines addiction as “. . . a chronic, relapsing brain disease that is characterized by compulsive drug-seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long lasting and can lead to the harmful behaviors seen in people who abuse drugs” (NIDA 2008a, p. 5).
Old and New Definitions
American Psychiatric Association
- Diagnostic and Statistical Manual of Mental Disorders
- DSM III and IV for past 40 years had one definition of Alcohol/Drug Abuse and one for Alcohol Drug Addiction/Dependence
- 2013- DSM V now has “Substance Abuse Disorder” with mild moderate and severe levels
(Older) Substance Abuse: DSM-IV-TR
- A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following occurring at any time in the same 12-month period:
Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
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(Older) Substance Dependence: DSM-IV
- A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period:
Substance often taken in larger amounts or over a longer period than intended
Persistent desire or unsuccessful efforts to cut down or control substance use
A great deal of time is spent in obtaining the substance
Important social, occupational, or recreational activities are given up or reduced because of substance use
Substance use continues despite knowledge of having a persistent or recurrent problem that is caused or exacerbated by the substance
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The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (APA 2013)
- DSM-5 combines substance abuse and substance dependence into a single condition called substance use disorder.
- The diagnosis of substance use disorder includes the following:
- Pharmacological – taking the substance in larger doses
- Excessive time spent obtaining the substance
- Craving the drug
- Social impairment: failure to meet goals and obligations
DSM-5 (APA 2013) (cont’d)
- Risky use of the substance: despite physical and/or psychological problems encountered
- Tolerance: The individual needs increased amounts to achieve the diminishing effects of the drug
- Withdrawal: Symptoms that can often leading to renewed substance dependence
Stages of Drug Dependence
- Relief satisfaction from negative feelings in using the drug
- Increased use involves taking greater quantities of the drug
- Preoccupation consists of a constant concern with the substance
- Dependency, the synonym for addiction, is when more of the drug is sought despite the presence of physical symptoms
- Withdrawal is physical and/or psychological effects from not using the drug
- Relapse or Recovery
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Figure 01.08: Stages of drug dependence
Addiction Includes Physical and Psychological Dependence
- Physical dependence refers to the body’s need to constantly have the drug or drugs (tolerance and withdrawal).
- Psychological dependence refers to the mental inability to stop using the drug or drugs (obsession, relapse, drug behaviors).
Why do some users become addicts?
- Most theories explaining “Why” people develop addiction fall into one of 3 categories
- Also known as Bio-Psycho-Social Model of Disease
Major Models of Addiction
- Moral Model: Poor morals and lifestyle; a choice
- Disease Model: A belief that addiction is both chronic and progressive, and that the drug user does not have control over the use and abuse of the drug
- Characterological or Personality Predisposition Model: Personality disorder, problems with the personality of the addicted
- Social Influence Theories- cultural beliefs and influences
Biological Explanations for the Use and Abuse of Drugs
- Biological: Genetic and biophysiological theories
- Addiction is based on genes, brain dysfunction, and biochemical patterns
- Biological explanations emphasize the effects of drugs on the central nervous system (CNS)
- Reward centers in some people are more sensitive to drugs, resulting in more pleasure and greater rewarding experiences from the use of drugs
– Drugs interfere with functioning neurotransmitters (neurotransmitters are chemical messengers used for communication between brain regions)
Three Principle Biological Theories
- Abused Drugs are Positive Reinforcers
- Most drugs with abuse potential enhance pleasure centers by causing the release of specific brain neurotransmitters such as dopamine
- Drug Abuse and Psychiatric Disorders
- Biological explanations are thought to be responsible for the substantial overlap that exists between drug addiction and mental illness
- Genetic Explanations
- Inherited traits can predispose some individuals to drug addiction.
Genetic Explanations for Contribution to Drug Abuse Vulnerability
- Character traits, such as insecurity and vulnerability, which is often found in many drug users/abusers may be genetically determined.
- Factors that determine how difficult it will be to break a drug addiction may be genetically determined.
Figure 02.B01A: High prevalence of drug abuse and dependence among individuals with mood and anxiety disorders.
Reproduced from U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Comorbidity: Addiction and Other Mental Illnesses. Research Report Series. NIH Publication Number 10-5771. Bethesda, MD: U.S. Department of Health and Human Services, 2010.
Genetic Factors Contribute to Drug Abuse Vulnerability
- Psychiatric disorders may be relieved by taking drugs of abuse, thus encouraging their use.
- Drug users may have reward centers in the brain that may be especially sensitive to addictive drugs.
- Addiction is a medical condition in the brain of addicts.
- Addiction is genetically determined, and people with this predisposition are less likely to abandon their drug of abuse.
Figure 02.01: Adolescent behavior problems and substance use in past month.
Reproduced from Substance Abuse and Mental Health Services Administration (SAMHSA). Study Shows Strong Relationship Between Adolescent Behavior Problems and Alcohol Use. Press Release. Rockville, MD: U.S. Department of Health and Human Services, 1 March 2000.
Psychological Explanations for
- Psychological theories regarding drug use and addiction mostly focus on mental or emotional states of drug users, the possible existence of unconscious motivations that are within all of us, and social and environmental factors.
- The American Psychiatric Association classifies severe drug dependence as a form of psychiatric disorder.
- Drugs that are abused can cause mental conditions that mimic major psychiatric illness.
Psychological Explanations for Drug Use/Abuse (continued)
- Psychological factors of addiction include:
- Escape from reality
- Inability to cope with anxiety
- Destructive self-indulgence (constantly desiring intoxicants)
- Blind compliance with drug-abusing peers
- Blindly using drugs without wanting to understand the harmful effects of drug use
- Self medicating (need the drug to feel better)
Theories Based on Learning
Humans acquire drug use behavior by the close association or pairing of one significant reinforcing stimulus (like friendship and intimacy) with another less significant or neutral stimulus (e.g., initial use of alcohol, marijuana, ecstasy, cocaine). In learning to use drugs the following occurs:
- Conditioning: The close association of significant reinforcing stimulus with another less significant or neutral stimulus
- Habituation: Repeating certain patterns of behavior until they become established or habitual
- “Addiction to pleasure” theory: Assumes it is biologically normal to continue a pleasure stimulus when once begun
Social Psychological Learning Theories
If the effects of drug use become personally rewarding, “or become reinforcing through conditioning, the chances of continuing to use are greater than stopping” (Akers 1992, p. 86).
Primary conditions determining drug use are:
- Amount of exposure to drug-using peers
- Extent of drug use in a given neighborhood
- Age of first use (exposure to drugs at younger ages results in greater difficulty in stopping drug use)
- Frequency of drug use among peers
- Social Influence Theories: Focus on microscopic explanations that concentrate on the roles played by significant others and their impact on the individual.
- Structural Influence Theories: Focus on macroscopic explanations of drug use and the assumption that the organizational structure of society has a major impact on individual drug use.
Social Influence Theories
- Social learning theory explains drug use as a form of learned behavior.
- Social influence and the role of significant others says the use of drugs is learned during intimate interaction
with others who, while
using the drug, serve as
a primary group.
© Vstock LLC/age fotostock
Social Influence Theories (continued)
- Labeling theory says people whose opinions we value have a determining influence over our self-image. Key factors in labeling theory include:
- Secondary deviance
- Master status
- Retrospective interpretation
– Can you define these four key factors used in
- Subculture theory explains that peer pressure is a determining cause of drug experimentation, use, and/or abuse.
Structural Influence Theories
- Structural Influence Theories: Focus on how the organization of a society, group, or subculture is largely responsible for drug abuse by its members
- Social Disorganization and Social Strain Theories: Drug use is caused by rapid and disruptive social change in society
- Control Theories: Belief that if people are left without attachments (bonds) to other groups (family, peers, social institutions), they have a tendency to deviate from expected cultural values, norms, and attitudes and use drugs
- Socialization: Internal and external controls
Low-Risk and High-Risk
- Low-risk drug choices refer to values and attitudes that lead to controlling the use of alcohol or drugs—self-monitoring your drug use, behavior, and abstinence.
- High-risk drug choices refer to developing values and attitudes that lead to using drugs both habitually and addictively, such as constantly searching for drinking and drug parties and hanging with drug abusers.
Figure 02.T02: Likelihood of Drug Use
Danger Signals of Drug Abuse
- Do those close to you often ask about your drug use? Have they noticed changes in your moods or behavior?
- Are you defensive if a friend or relative mentions your drug or alcohol use?
- Are you sometimes embarrassed or frightened by your behavior under the influence of drugs or alcohol?
Danger Signals of Drug Abuse (continued)
- Have you ever gone to see a new doctor because your regular physician would not prescribe the drug you wanted?
- When you are under pressure or feel anxious, do you automatically take a depressant, stimulant, or drink?
- Do you take drugs more often or for purposes other than those recommended by your doctor?
Danger Signals of Drug Abuse (continued)
- Do you mix other types of drugs with alcohol?
- Do you drink or take drugs regularly to help you sleep?
- Do you have to take drugs to relieve boredom or get through the day?
- Do you personally think you may have a drug problem?
- Do you avoid people who do not use drugs?
- Do you believe you cannot have fun without alcohol or other drugs?
Major Risk Factors for Addiction
- Alcohol and/or other drugs used alone
- Alcohol and/or other drugs used in order to reduce stress and/or anxiety
- Availability of drugs
- Abusive and/or neglectful parents; other dysfunctional family patterns
- Misperception of peer norms regarding the extent of alcohol and/or drug use (belief that many other people are using drugs)
- Alienation factors, like isolation and emptiness
Major Risk Factors for Adolescents
- Physical or sexual abuse (past and/or present)
- Peer norms favoring drug use
- Misperception and/or power of age group peer norms
- Conflicts, such as dependence versus independence, adult maturational tasks versus fear, and low self-esteem.
© BananaStock/age fotostock
Major Risk Factors for Adolescents (continued)
- Teenage risk-taking and view of being omnipotent and invulnerable to drug effects
- Drug use viewed as a rite of passage into adulthood
- Drug use perceived as glamorous, fun, facilitating, and intimate
Electronic social media influences like photos of drinking posted on MySpace
© Simone van den Berg/ShutterStock, Inc.
Major Risk Factors for Adults
- Loss of meaningful role or occupational identity due to pending retirement
- Loss, grief, or isolation due to divorce, loss of parents, or departure of children (“empty nest syndrome”)
- Loss of positive body image
- Dealing with a newly diagnosed illness (e.g., diabetes, heart problems, arthritis, cancer)
- Disappointment when life’s expectations are clearly not met