WHY A COURSE ON ADDICTIVE BEHAVIORS?WHY A COURSE ON ADDICTIVE BEHAVIORS?

• Study of Drug Use and Misuse Important

• A part of life in our culture - pervasive

• Affects everyone: we all have choices to make about what we do and don’t do, what we ingest and what we avoid

• Can have harmful consequences for individual, family, community, and society

• Substance use disorders are both preventable and treatable

• We are constantly being presented with information about licit and illicit substances and activities - how do we evaluate it?

OVERARCHING PRINCIPLESOVERARCHING PRINCIPLES

• Study of Drug Use and Misuse has Experiential and Scientific Basis

• The Continuum: Drug Use, Misuse, and Dependence

• All Drugs and Potentially Addictive Behaviors Have a History and Cultural Context:

Drugs neither good nor bad per se

• e.g., religious, spiritual usage; use for health / medical reasons

Dependence Potential of Psychoactive DrugsVery High: Heroin (IV)

Crack cocaineHigh: Morphine

Opium (smoked)Moderate/High: Cocaine powder

Tobacco cigarettesPCP (smoked)

Moderate: Diazedpam (Valium)AlcoholAmphetamines (oral)

Moderate/Low: CaffeineMDMA(Ecstasy”)Marijuana

Low: Ketamine

Very Low: LSD, MescalinePsilocybin

Influences on Drug Use

Figure 1-4

1-5

(a) Relationship of Risk Factors (b) Relationship of Protective Factors

Figure 1-3

1-4

Drug Use, Misuse, and “Addiction”Drug Use, Misuse, and “Addiction”

• What is a drug?

• What is an addiction? An addict?___________

• Themes associated with “addiction” ______________________________

____________________________________________________________

Moral / Temperance Model * Addiction as Sin or Crime Personal Irresponsibility

Disease Model * Genetic and Biological Factors **12-Step Framework; Abstinence

Education as Treatment

Behavioral and Cognitive- Conditioning and ReinforcementBehavioral Models * Social Learning and Modeling

Drug Expectancies and other Cognitive Factors / RP

Family Models Family DiseaseFamily SystemsBehavioral Marital/Family Tx

Psychological / Psychoanalytic Disordered /Addictive Personalities

Sociocultural Models Cultural Factors

Socioeconomics/ Social Policy

Drug Subcultures

Public Health Model Agent, Host, Environment Interactions

THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION

MODELS OF ADDICTION: A SUMMARY

Moral / Temperance Model Addiction as Sin or Crime Personal Irresponsibility

Disease Model Genetic and Biological Factors

12-Step Framework; Abstinence, Education as Treatment

Psychological / Psychoanalytic Disordered /Addictive Personalities

Behavioral and Cognitive- Conditioning and Behavioral Models Reinforcement

Social Learning / Modeling

Drug Expectancies and other Cognitive Factors / RP

Family Models Family Disease

Family Systems

Behavioral Marital/Family Therapy

Sociocultural Models Cultural Factors

Socioeconomic Factors

Drug Subcultures

Social Policy (e.g., drug control)

Public Health Model Interactions between

Agent Host Environment

THE BIOPSYCHOSOCIAL MODEL: AN INTEGRATION

MODELS OF ADDICTION: A SUMMARY

Psychological / Psychoanalytic Disordered /Addictive Personality

Sociocultural Models Cultural FactorsSocioeconomics/ Social Policy Drug Subcultures

Public Health Model Agent, Host, Environment Interactions

THE BIOPSYCHOSOCIAL MODEL:AN INTEGRATION

MODELS OF ADDICTION: A SUMMARY

SUBSTANCE USE DISORDERSSUBSTANCE USE DISORDERS

DSM-IV CRITERIA FOR SUBSTANCE DEPENDENCE

- need at least 3 of the following within 12-month period-symptoms present at least 1 month or occur repeatedly

over time

_______________________________

_______________________________

_______________________________

_______________________________

SUBSTANCE USE DISORDERS SUBSTANCE USE DISORDERS

CRITERIA FOR SUBSTANCE DEPENDENCE

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Substance use is continued despite: ___________________________________________________________________________________________________

SUBSTANCE USE DISORDERS SUBSTANCE USE DISORDERS

NEW DSM-V CRITERIA FOR SUBSTANCE ADDICTION (DEPENDENCE)

DSM-V SUBSTANCE CLASSES(p. 482 in DSM-5)

DSM-V SUBSTANCE CLASSES(p. 482 in DSM-5)

Diagnoses Associated with Substance Class

Psychotic Bipolar Depressive AnxietyOCD & related

Sleep Sexual DeliriumNeuro-cognitive

Sbst. use Intoxication Withdrawal

Alcohol I/W I/W I/W I/W I/W I/W I/W I/W/P X X X

Caffeine I I/W X X

Cannabis I I I/W I X X X

Hallucinogens Phencylidine I I I I I X X Other Hallucinogens I* I I I I X X

Inhalants I I I I I/P X X

Opioids I/W W I/W I/W I/W X X XSedatives, hypnotics, or anxiolytics I/W I/W I/W W I/W I/W I/W I/W/P X X X

Stimulants** I I/W I/W I/W I/W I/W I/W I X X X

Tobacco W X X

Other I/W I/W I/W I/W I/W I/W I/W I/W I/W/P X X X X = category is recognized in DSM-5

I = specifier "with onset during intoxication" may be noted for the category

W = specifier "with onset during withdrawal" may be noted for the category

I/W = either of the above specifiers may be noted

P = the disorder is persisting

*also hallucinogen persisting perception disorder (flashbacks)

**includes amphetamine-type substances, cocaine, & other or unspecified stimulants