Transcript Chapter 2

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.