Transcript Addiction - Drogriporter

FIVE QUESTIONS:
1. What is addiction?
2. How do addicts differ from others?
3. What thinking causes addiction?
4. What cultures cause addiction?
5. Is addiction decreasing/increasing?
MODELS
OF
ADDICTION
Disease Model of Addiction
 Inbred/biological

Loss of control
 Lifelong/permanent

Inevitable progression

Requires medical/spiritual treatment
Neurochemical Model

Addiction operates through dopamine

Drugs elevate dopamine  pleasure

Neuroadaptation  dependence

Requires treatment  chemical blocks

Leshner: “It's a myth that millions of people get
better by themselves.”
ADDICTION IS…
Understanding brain
chemistry, not building up
willpower, is the key to
preventing adolescent alcohol
and other drug addiction.
Source:
Nora Volkow, director, National Institute of Drug Abuse (NIDA).
Cognitive-Behavioral Model
 Alter thinking  action

Present oriented
 Skills oriented
- internal/cognitive
- external/practical

Coping/problem solving
- applied to substance abuse
- dysfunctional thinking  cycle
THE CONCEPT
OF
ADDICTION
Problems
with the
Addiction Concept
Which drugs are addictive?
ILLICIT

cocaine

marijuana
LEGAL

nicotine

caffeine

antidepressants
Are Addictive Drugs
Always Addictive

hospital patients

the clinical bias

Vietnam
What Happened in Vietnam?
Of all those addicted…

60% used narcotics stateside

12% re-addicted any time

6% addicted after three years
What is Addiction?
Source:
Stanton Peele, Diseasing of America,
San Francisco: Jossey-Bass.
Vietnam
vs.
Home Environments

Fear and privation

-Control

-Positive options

-Social support

-Values of moderation
Addictive Criteria

Absorbing

Predictable

Sense of control / value

Illusory

Deepening / worsening
Gambling Example

Absorbing activity

“Predictable”

Sense of value and control

Growing penalties
ADDICTION IS…
an absorbing activity that
provides essential emotional
rewards otherwise not
available to one that entails
growing life detriments.
Source:
Stanton Peele, The Meaning of Addiction,
San Francisco: Jossey-Bass.
Sources of Addiction

Stressed environments

Lack of satisfaction

Lack of moderating influences

Lack of coping skills

Lack of self-efficacy
HOW CAN LOVE BE
ADDICTIVE?
Causes of Relapse
Two factors predicted relapse
following treatment:
“lack of coping skills and belief in
the disease model of alcoholism.”
Source:
Miller, W.R., Westerberg, V.S., Harris, R.J., et al. (1996). What predicts relapse?
Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-171.
NATURAL RECOVERY &
THE PROCESS OF CHANGE
Illicit Drug Use
Lifetime, Past Month, Ages 12+: Percentages, 2002
Lifetime
Cocaine
Last Month
Last Month/
Lifetime
15
1
7
Crack
3
.3
9
Heroin
2
.1
6
Source: SAMHSA (2003, Table 1.1B)
Addiction and Age
Age
16-17
18-25
26-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
% Abuse/Dep
17
22
15
12
11
9
8
7
3
4
1
NESARC
2001-2002 National Epidemiologic
Survey on Alcohol and Related
Conditions (NESARC) :
43,093 in-person interviews
4422 DSM-IV alcohol dependent
Source:
Dawson, D.A., Grant, B.F., Stinson, F.S., & Chou, P.S., et al. (2005). Recovery from DSM-IV
alcohol dependence: United States, 2001-2002. Addiction, 100, 281-292.
NESARC Past-Year Improvement
Among Alcoholics
(columns percentaged)
Treated Untreated
Past Year Status
(n=1,205)
(n=3,217)
Dependent
28
24
Abstinent
35
12
Drinking w/o dependence
36
64
Source: Dawson et al. (2005)
Summarizing NESARC
 Most alcoholics untreated
 Treated alcoholics do no better
 Most alcoholics cut back drinking
 What were these people thinking?
 Implications for treatment/policy
HARM REDUCTION
THERAPY
What is harm
reduction?
Principles of Harm Reduction
 Consequences of behavior

Non-abstinence outcomes
 Client-centered

Low threshold / low commitment

Pragmatic
Marlatt, A. (1996). Harm reduction: Come as you are. Addictive
Behavior, 21, 779-788.
Is harm reduction
accepted?
Why not?
SCIENTIFIC RESEARCH
ON ALCOHOLISM
EFFECTIVE THERAPIES
Effective Alcoholism Treatments
CES *
Severity
Brief interventions
390
2.47
Motivational enhancement
189
2.72
GABA (Acamprosate)
116
3.80
Community reinforcement
110
3.43
Self-help manual
110
2.59
*Cumulative Evidence Score
Source: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism
Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon.
Ineffective Alcoholism Treatments
CES*
Severity
Twelve-step facilitation
-82
3.67
Alcoholics Anonymous
-94
3.14
Confrontational counseling
-183
3.00
General alcoholism counseling -284
3.22
Education (tapes, lectures)
2.44
-443
* Cumulative evidence score
Source: R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism
Treatment Approaches (3rd Ed.). Boston: Allyn and Bacon. (3rd Ed.).
Boston: Allyn and Bacon.
HOW DO PEOPLE
REALLY CHANGE?
BI/MI – What Is Common?
 Minimal time in therapy
 You must change
 True to your values
 Self-efficacy
 Harm reduction
Patient Resources + Outcomes
Treatment or No

Stable marriage

Social/community stability

Higher socioeconomic functioning

Higher intellectual functioning

Employment - Job skills

Motivation to change

Ability to cope with stress
A Different View of Addiction

People change the more resources they have

They are helped by summoning the resources they
possess

Treatment assists by helping them gather resources

Treatment not essential
Assessing Resources:

Intimacy and supportive relations

Work skills and accomplishments

Activities and interests

Coping with your world

Coping with yourself

Beating previous addictions
Stages of Change:
How People Really Do It
 Believe that the addictive involvement violates more important
values.
 Want to quit/ and believe you can.
 Develop alternative rewards that are more meaningful than
addiction.
 Find/develop resources in life to maintain rewards.
Stages of Change:
How People Really Do It
(continued)
 Rely on friends, family, and groups to help support the
change in behavior.
 Avoid situations and ways of thinking that provoke
relapse.
 Eventually develop a new self-image, a view of
oneself as a former addict.
 Develop higher goals than addiction.
ARE ALL SOCIETIES EQUAL?
ALCOHOL
Alcohol and Moderation
Ireland vs. Italy
% of men who
Drink every day
Binge 1+/week
Ireland
Italy
2
42
48
11
Source: European Comparative Alcohol Study
Norstöm, T. (Ed.). (2002). Alcohol in postwar Europe: Consumption,
drinking patterns, consequences and policy responses in 15 European
countries. Stockholm: SW: National Institute of Public Health, pp. 196205.
Drunken 15-16 year olds
Country
% Drunk 10+/year
Denmark
Finland
U.K.
Ireland
Iceland
39
29
28
27
19
+++
Greece
Malta
Portugal
France
Italy
4
4
4
3
2
Source: Plant, M., & Miller, P. (2001). Young people and
alcohol. Alcohol & Alcoholism, 36, 513-515.
Non-Temperance Recipe

Regular consumption

With meals

Across gender, age groups

Drinking + / drunkenness -
Model for Moderation

Drinking is regular, accepted

Bad drinking, good drinking taught

Bad behavior not excused by drinking
PROTECTING AMERICAN
YOUTH
Monitoring the Future 2004
Drinking by U.S. H.S. Seniors
Behavior
Drank in last year
71%
Drunk in last year
52%
Drunk in last month
33%
Attitudes
Disapprove of 1 or 2 drinks/daily
76%
Disapprove 5+ drinks weekends
66%
Source: Johnston, L.D.. National Results on Adolescent
Drug Use: Overview of Key Findings, 2004. Bethesda,
MD: National Institute on Drug Use, 2005.
What are kids most likely to
be addicted to?
Are children not sufficiently
protected?
Heavily protected
Echo boomers are the most watched-over
generation in history. Most have never
ridden a bike without a helmet, ridden in a
car without a seat belt, or eaten in a cafeteria
that serves peanut butter.
Source: 60 Minutes, “The Echo Boomers”
Not independent
“Sometimes, they don't know what to do if
they're just left outside and you say, ‘Well,
just do something by yourself for a while’
They'll look around stunned.”
Source: 60 Minutes, “The Echo Boomers”
Not independent
"Parents feel as if they're holding onto a piece of
Baccarat crystal or something that could
somehow shatter at any point. They have a sense
their kids are fragile. Parents therefore are
protecting them, inflating their egos, massaging
them, fighting their battles for them."
Source: 60 Minutes, “The Echo Boomers”
Immediate gratification
“Everything has to be immediate, like a video game.
And they have a lot of trouble doing things in a
stepwise fashion, delaying gratification.”
Source: 60 Minutes, “The Echo Boomers”