Transcript Medical Model Tues Jan 17

LECTURE TWO: ADDICTION
The Medical Model
Let’s Look at the MAST
Michigan Alcoholism Screening Test (MAST)
Scoring the Mast
For each yes give yourself the score indicated except for questions 1,4, and 8.
For 1,4, and 8, give yourself the score indicated if you give A NO Answer
Zero points for a Yes answer 1,4,8.
• 12 or more points indicates a problem with alcoholism
• 5 and 10 suggestive of problem at risk
DSM IV-TR Criterion for: Alcohol Dependence - Diagnostic Code 303.90
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress,
as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of alcohol to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of alcohol
(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for alcohol
(b) alcohol (or a closely related drug such as valium) is used to relieve or avoid withdrawal symptoms
(3) alcohol is often used in larger amounts or over a longer period than was intended
DSM criteria (cont.)
4) there is a persistent desire or unsuccessful efforts to cut down or control
alcohol use
(5) a great deal of time is spent in activities necessary to obtain alcohol, use
alcohol, or recover from its effects
(6) important social, occupational, or recreational activities are given up or
reduced because of alcohol use
(7) alcohol use is continued despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have been caused
or exacerbated by alcohol
Specifiers
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With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1
or 2 is present)
Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither
Item 1 nor 2 is present)
(Note--a diagnosis of Alcohol Dependence can never be changed to a diagnosis of
Alcohol Abuse. A diagnosis of Alcohol Dependence is for life--it can never be removed
from your medical chart not matter how much you improve.)
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 center 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



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 after starting
 His
legacy – something worth studying (brain/biology)
 Removes prejudices “the immoral alcoholic”
 Wasn’t about will power was a “disease”
Genetic Inheritance Theories

Less sensitive to alcohol effects –
(less neuronal firing)

Like / dislike certain substance(s)

Decision making (frontal cortex)

Make it harder to quit

Affect withdrawal syndrome



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

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
20% chance of becoming
alcoholic regardless of SES


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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 bio-transform 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