Chapter 2 Why Do People Abuse Drugs? A Better Understanding of Models and Theories of Drug Dependence and Addiction ©2010 McGraw-Hill Higher Education. All rights reserved. Reasons for Using Drugs/Alcohol Innate drive to alter consciousness (e.g., daydreaming vs. reality) Passive (not active) activity – easy way to overcome boredom Affect (feeling) regulation ©2010 McGraw-Hill Higher Education. All rights reserved. FLOW Defined “So involved in an activity that nothing else seems to matter.” “When consciousness is harmoniously ordered, pursue what you are doing for the sheer sake of doing it.” Source: Flow: The Psychology of Optimal Experience, by Mihaly Csikszentmihalyi, Tarcher/Putnum, 1992 ©2010 McGraw-Hill Higher Education. All rights reserved. Models 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Disease model Genetic model -adoption studies/twin studies Self-medication (Khantzian, 1985) Personality traits Personality disorders Mood & Affect disorders Family model Poor self-concept Psycho-social social learning Socio-cultural ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Substance Abuse General acceptance of multiple causes, a matrix of both Genetic & Environmental factors. No one model explains all substance abuse. ©2010 McGraw-Hill Higher Education. All rights reserved. Disease Model 1957 AMA declares Alcoholism a disease based on 3 factors – – – 12 step approach based on the disease model – – Known etiology (cause) Symptoms get worse over time Known outcomes Assumes alcoholic/addict is predisposed to addiction Genetically transmitted at-risk factors Genetic-Influence Disease Model – Assumes multiple biological risk factors interact with psychosocial factors ©2010 McGraw-Hill Higher Education. All rights reserved. Genetic Model Adoption studies – – Twin studies – Sons of alcoholics – 4 times more likely to be alcoholic Daughters of alcoholic fathers – have more somatic anxiety and frequent physical complaints Higher rate of alcoholism in monozygotic twins Devors – Developmental Genetic Model – – Not a single disorder; a group of illnesses Ebbing influence of genes and environment ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Substance Abuse 1. 2. 3. 4. 5. 6. Personality Tension Reduction models Psychoanalytic model Family model Psychosocial models – social learning theory Sociocultural models ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Personality Addictive personality – cannot be identified Personality traits and disorders (POs) that make one vulnerable to addiction Cloninger identified a three-dimensional model of personality for addiction – Harm avoidant – cautious, apprehensive, fatigable, inhibited – Reward dependent – ambitious, sympathetic, warm, industrious, sentimental, persistent, moody – Novelty seeking – impulsive, excitable, exploratory, quicktempered, fickle, extravagant ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Tension Reduction Model Homeostasis (the mobile theory) to balance out – stress, anxiety, conflict, frustration. What is familiar, often drama (think of the “tails” of the bell curve) Henecke – sons of alcoholics are stimulus augmenters, alcohol is used to shut down the stimulation overload ©2010 McGraw-Hill Higher Education. All rights reserved. Tension Reduction Model (cont’d) Boredom has many forms including: – – – Existential boredom Is my life meaningful? Interpersonal boredom Are my relationships satisfying? Leisure time boredom Do I get enjoyment from activities other than my obligations? ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Psychoanalytic Model Fixation at the oral stage of development – resulting in a narcissistic personality Structural deficit in object relations – results in difficulty in establishing interpersonal relationships – defense grandiosity as a defense Meaning of drugs – as power, self-destruction, seduction and sexuality ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Family Model A disease that effects all family members Resolution of dysfunctional issues, boundaries and healing of trauma The “mobile” model of the family being out of balance because of the “pull” from the addict The “identified patient” as focal point to avoid change ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Psychosocial Models – Social Learning Theory (SLT) Learn in various ways to abuse drugs – Conditioning/learned response: “euphoric” recall Marlatt and Gordon emphasized: – – Addictive behaviors are a category of “bad habits” (or learned behaviors). Addictive behaviors are learned habits (behaviors can change; genetics cannot but can sometimes be treated with medication, etc.) ©2010 McGraw-Hill Higher Education. All rights reserved. Models of Abuse Sociocultural Models Bales – the influence of the culture on rates of alcoholism, based on: degree to which a culture causes acute needs for adjustment of inner tension attitudes toward drinking degree to which the culture provides substitute means of satisfaction ©2010 McGraw-Hill Higher Education. All rights reserved. Theories of Drug Use Self-Medication Motive Khatzian – – Drug use is not a random phenomenon Purposeful to: Assuage painful affective (feeling) states; An attempt to alleviate pain through self medication Manage psychological problems Manage personality traits and disorders Explore the self-medication motive – – To find other ways to better cope with the affective states & psychological problems: Dealing with psychological vulnerability ©2010 McGraw-Hill Higher Education. All rights reserved. Dealing with Severe Trauma (PTSD) The American Medical Association defines trauma as: – Witnessing an event that involves actual or threatened death. – NOT only related to war. – NOT only a head injury that resulted in being unconscious. – NOT only Loss of memory. “Trauma stressors” include: – Natural disasters – Vehicle accidents – Intimate partner violence and stalking ©2010 McGraw-Hill Higher Education. All rights reserved. Theories of Drug Use Personality Theory Specific personality traits of alcoholics/addicts Impulsivity/”dis”-inhibition Risk taking behavior Personality disorders – narcissism, borderline – strong correlation with substance abuse ©2010 McGraw-Hill Higher Education. All rights reserved. Theories of Drug Use Depression, Mood and Feelings Major depression and dysthymia (low grade depression) occur 1.5-2 times more in alcoholics Female alcoholics have a 10 times higher incidence of mania Male alcoholics have a 3 times higher incidence of mania Begins with self-medication for negative affect states, and can spiral into a pattern of isolation & interpersonal distancing Feeling of hopelessness, pessimism (Seligman’s Positive Psychology Theory), poor future orientation lead to depressive thinking Yapko described poor future orientation as contributing to depression ©2010 McGraw-Hill Higher Education. All rights reserved. Personality Traits of Addicts/Alcoholics High emotionality Anxiety & over reactivity Inability to express anger adequately Immaturity in interpersonal relationships ©2010 McGraw-Hill Higher Education. All rights reserved. Ambivalence to authority Anger over dependence Low self-esteem with grandiose behavior Perfectionism compulsiveness Personality Traits cont’d Feelings of isolation Depression Sex role confusion – sexual immaturity Dependence in interpersonal relationships ©2010 McGraw-Hill Higher Education. All rights reserved. Hostility Rigidity – inability to adapt to changing circumstances Simplistic black and white thinking Optimism and Pessimism OPTIMISM PESSIMISM Very temporary Permanent Specific Pervasive External Personalized Source: Learned Optimism, by Martin E.P. Seligman, Ph.D., Pocket Books, 1992 ©2010 McGraw-Hill Higher Education. All rights reserved. Adolescent Drug Abuse Paul Robinson in “Beyond Drug Education” emphasized: – Controlling destructive impulses is the primary means of controlling drug abuse for adolescents Learning to PAUSE before acting is a learnable behavioral change ©2010 McGraw-Hill Higher Education. All rights reserved.