Transcript Class 3 Mdeical Model

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
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1.
2.
3.
4.
5.
6.
7.
Score one point if you answered the following
No
Yes
Yes
No
Yes
Yes
7 through 22: Yes
Scores mean?

0 – 2 no apparent problem

3 – 5 Early or Middle Problem drinker
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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

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
Past
Present
Future
• It’s Important to remember that chemical abuse patterns are not fixed
• Moreover, no one sets out to become addicted
MEDICAL MODEL OF ADDICTION
or Disease Model
Basic Tenet: Medical Model / Disease Model
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
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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
Alcohol used for
relief from social
tension
Crucial Phase
Loss of control;
withdrawal,
preoccupation
Prodromal Phase
First Blackouts;
preoccupation with
use, development
of guilt
Chronic Phase
Loss of tolerance;
obsessive drinking,
alcoholic tremors
Genetic Inheritance Theories

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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
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Addicts
are
biologically
different from non-addicts
An addict’s brain acts
differently before and after
using
Addicts metabolize and biotransform
substances
differently
Ego States and the Characterlogical
Model of Addiction
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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