LECTURE THREE Addiction: What is it or what is it Not

Short Group Exercise Your row’s task is to create a definition of

addiction and then present it to the class

Looking at the MAST

Let’s Look at the MAST Score one point if you answered the following

1. No 2. Yes 3. Yes4. No5. Yes 6. Yes 7. 7 through 22: Yes

Scores mean?

0 – 2 no apparent problem

3 – 5 Early or Middle Problem drinker

6 or more Problem Drinker

Why do people abuse chemicals?

The simplest answer is because it feels good!

But why then are we not all addicts?

Is it not a choice?

What do folks think?

Is it simple a choice?

Physical reward potential

Increased sense of pleasure

Decreased discomfort

Thus I use again and again

Social Learning Component

Individual Expecta

tion of

Drug/Alco

hol / Substa

nce

Individual Expecta

tion of

Drug/Alco

hol / Substa

nce

We learn how to use drugs and substances

In order to maximize their potential both physically and psychologically.

Cultural influences on chemical use patterns

People’s decision to use or not can be a result of the community, subculture, family, and social group, to which you belong.

Peele [1985] holds that “cultures where use of a substance is comfortable, familiar, and socially regulated both as to style of use and appropriate time and place for such use, addiction is less likely and maybe practically unknown”.

And yet with new emerging addictions this may not hold as true as it did 20 years ago!

What is Peele Smoking?

We also can’t forget social groups within a culture

Individual Life Goals

Present Future

Past

• It’s Important to remember that chemical abuse patterns are not fixed

• Moreover, no one sets out to become addicted

MEDICAL MODEL OF ADDICTIONor Disease Model

Basic Tenet: Medical Model / Disease Model A great deal of the individuals behavior is

based on predisposition

However, there is no universally accepted disease model that explains addiction

Instead there exists loosely related theories that addiction is (unproven) psycho-biomedical processes that can be called a disease state.

Otto Jellinek (1952) Influenced physicians

Shifted from moral disorder to medical disorder

Became recognized as formal disease in 1956

Proposed alcoholism to be a progressive / predictable disorder

Jellinek’s Four Stage Model

Prealcoholic Phase

Prodromal Phase

Crucial Phase Chronic Phase

Alcohol used for relief from social tension

First Blackouts; preoccupation with use, development of guilt

Loss of control; withdrawal, preoccupation

Loss of tolerance; obsessive drinking, alcoholic tremors

PROGRESSI

VEE

COURSE

LEADING

TO DEATH

PROGRESSI

VEE

COURSE

LEADING

TO DEATH

Genetic Inheritance Theories More or Less sensitive to

alcohol effects – (reward pathway); (like dislike substance)

Decision making (frontal cortex)

Make it harder to quit

Affect withdrawal syndrome

Different studies suggest that genes account for 20% to 50% of addiction risk

No signal gene causes addiction

Vulnerability not Destiny

Cloninger’s Type 1 and Type 2 Alcoholics 3,000 adoptees

Reared by non-alcoholic parents

Great deal of adoptees became alcoholic

Cloninger observed two distinct groups

Type 1 (larger subgroup) ¾ children had

biological parents who were alcoholic

These children drank in moderation in early adulthood

Later life developed dependence

Functioned in society as responsible adults

If raised in higher socio-economic family – less likely to become alcoholic

Type 2 Males

More violent than Type 1

Father’s were violent alcoholics

Later studies confirmed findings

10% of sample became alcoholics

Low Levels of MAO

Neuro-Biological Processes, Dopamine, and Drug Addiction

Addicts are biologically different from non-addicts

An addict’s brain acts differently before and after using

Addicts metabolize and bio-transform substances differently

Ego States and the Characterlogical Model of Addiction Personality and its relationship with self and

world (internal and external)

How we then deal with world

Addiction then helps to self-regulate via pharmacologic effects, attendant rituals, practices, and drug culture