Transcript Addiction and the Medical Model

LECTURE TWO: ADDICTION
Medical Model
Defining Addiction: The Experts Way In
DSM SAYS THERE
ARE THREE
COMPONENTS

CRAVING AND
COMPULSION

LOSS OF CONTROL

CONSEQUENCES
DSM-IV-TR Criterion for Alcohol Dependence
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?
Is it simple a choice
Physical reward potential
Increased sense
of pleasure

Decreased
discomfort
Pleasure center is not one a single
center

Pleasure centers across brain systems

Motivated to seek further stimulation
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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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) a psycho-biomedical process 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 (by the AMA)

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;
Physically
dependent
Prodromal Phase
First Blackouts;
preoccupation with
use, development
of guilt
Chronic Phase
Loss of tolerance;
obsessive drinking,
alcoholic tremors,
drinking with social
inferiors
Jellinek’s Additions


Later classified different types of alcoholics
One hallmark of the alcoholic – they can’t predict
how much they will drink
 His
legacy – something worth studying
 Removes prejudices of the immoral alcoholic
 Wasn’t about will power was a “disease”
Genetic Inheritance Theories
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Less sensitive to alcohol effects –
(less neuronal firing)
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Like / dislike certain substance(s)
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Decision making (frontal cortex)
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Make it harder to quit
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Affect withdrawal syndrome
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Different studies suggest
that genes account for
20% to 58% 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
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Great deal of adoptees became alcoholic

Cloninger observed two distinct groups
Type 1 (larger subgroup)

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¾ children had biological
parents who were alcoholic
These children drank in
moderation in early
adulthood
Later life developed
dependence

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Functioned in society
as responsible adults
If raised in higher
socio-economic family
less likely to become
alcoholic
Type 2
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Males
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More violent than Type 1
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Father’s were violent
alcoholics
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20% chance of
becoming alcoholic
regardless of SES
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Later studies
confirmed findings
Women were also
found to fit Type II
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