Transcript Rieger Chapter Summaries PowerPoint 07

CHAPTER 7
ADDICTIVE BEHAVIOURS
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Aims and Objectives
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Provide diagnostic criteria for substance use disorders and
pathological gambling
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Review information regarding prevalence, age of onset,
course, and problems associated with these disorders
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Discuss current biopsychosocial perspectives on aetiology
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Describe treatments for addictive behaviours
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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The diagnosis of substance use disorders
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Substance dependence
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Current DSM criteria includes complex cluster of
cognitive/psychological, behavioural, and physiological symptoms
occurring for at least 12 months
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Withdrawal - symptoms that occur when an individual stops using
substance
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Alcohol: autonomic hyperactivity, nausea/vomiting, shakiness
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Opioids: nausea/vomiting, diarrhoea, insomnia, muscle aches
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Stimulants: fatigue, sleep disturbances, psychomotor agitation/retardation
Substance abuse
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Substance problems that do not meet for dependence
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Maladaptive pattern of substance use that results in considerable
impairment in functioning or distress over 12 month period
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Epidemiology of substance use disorders
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Prevalence
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Alcohol most commonly used drug in Australia
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10% of population meet for harmful use or dependence
Substance use disorders diagnosable in an additional 1.6%
Age of onset and course
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Disorders predominantly of the young, decrease in prevalence with age
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High rates of mortality from excessive use of alcohol from accidents,
violence, and suicide, as well as medical complication such as liver
cirrhosis
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Drug abuse and dependence a leading cause of death of young people
from trauma, suicide, overdose and infectious disease such as HIV
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Aetiology of substance use disorders
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Impaired control versus choice theories
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Disease Model of Addiction describes addiction as a medical
disorder characterised by brain impairment
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In contrast, other models suggest that the maladaptive use of
substance reflects a rational choice (Skog, 2000)
Biological factors
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Substance use disorders tend to cluster in families
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Adoption and twin studies also support genetic factors
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The genetic basis of substance use disorders is thought to be nonspecific
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Addictive substances act on the brains reward systems
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Dopaminergic reward system thought to be most important
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Endogenous opioid system
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Inhibition Dysregulation Theory- impairment of inhibitory system
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Aetiology of substance use disorders
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Psychological factors: behavioural theories
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Instrumental or Operant Learning Model
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Positive reinforcement = experience of pleasure
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Negative reinforcement = alleviation of symptoms of withdrawal
Opponent-process Theory of Addiction – feedback loop
Classical conditioning – unrelated stimuli become associated with
drug
Incentive-Sensitisation Theory – drugs change the area of the brain
responsible for the incentive to use drugs
Psychological factors: personality theories
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Cloninger’s Tri-Dimensional Personality Theory
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Novelty seeking, harm avoidance, reward dependence
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Aetiology of substance use disorders
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Psychological factors: cognitive theories
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Outcome Expectancy Theory – individuals’ expectations of positive
consequences from substance use increase propensity to use
Beck’s Cognitive Theory of Substance Use – network of maladaptive
beliefs
Relapse Prevention Theory – individuals in high-risk situations will
relapse if they do not have coping strategies, self-efficacy, etc.
Social and cultural factors
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Familial influences
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Family functioning – ineffective parenting, negative communication
patterns
Parental modelling of their own substance use
Peer influences
Cultural influences – availability, cost, and social acceptability
of substance
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Treatment of substance use disorders
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Detoxification
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Not a treatment, but may be a useful first step
Appropriate therapeutic goals
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Abstinence versus controlled use
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Controlled drinking may be an appropriate goal for some patients
Motivational enhancement therapy (Miller & Rollnick, 2002)
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Used for individuals with low motivation to change
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Based on Stages of Change model (Prochaske & DiClemente, 1986)
Brief and early interventions
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Limited contact with health professional
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Assessment, feedback, and educational material
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Found to be beneficial for use of alcohol, amphetamines and cannabis
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Treatment of substance use disorders
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Skills training approaches
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Pharmacological interventions
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Block rewarding effects of the substance (e.g., naltrexone)
Used as a less-harmful substitute (e.g., methadone)
Reduce severity of withdrawal symptoms (e.g., nicotine patch)
Relapse prevention
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Communication skills, problem-solving, assertiveness skills, relaxation
and stress management skills have all been effective for alcohol
problems
Importance of anticipating high-risk situations
Continuing to develop coping skills
Comorbid psychological disorders
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High comorbidity with other mental disorders
Must target these disorders during treatment
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Definition of pathological gambling
3 categories of gambling: gaming, wagering and lotteries
 People are motivated for entertainment and to win money
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Types of gamblers
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Social, non-problem gamblers – gambling within affordable limits
Problem gambling – characterised by difficulties limiting money and/or
time spent on gambling, which leaves to adverse consequences
Pathological gambling – severe end of the problem gambling
spectrum, impaired control manifested by repeated, failed attempts to
stop or reduce gambling despite significant negative consequences
Historical approaches
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Gambling and gaming have existed since antiquity
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Interest in problem gambling began with psychoanalytic movement
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First classified as a psychological disorder in DSM-III (1980)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Diagnostic criteria for pathological gambling
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DSM-IV-TR defines pathological gambling as persistent and
recurrent maladaptive gambling behaviour indicated by at least
5 of the following:
1. The individual is preoccupied with gambling
2. The individual needs to gamble with increasing amount of money
3. The individual has made repeated unsuccessful attempts to cut down or stop
4. The individual is restless or irritable when attempting to quit
5. The individual gambles as a way to escape problems or negative mood
6. After losing money, the individual returns to get even, referred to as “chasing”
7. The individual lies to others to conceal extent of gambling
8. The individual has committed illegal acts to finance gambling
9. The individual lost/jeopardised significant relationship, job, etc.
10. The individual relies on others for money for a desperate financial situation
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Diagnostic criteria for pathological gambling similar to
substance dependence, but pathological gambling is classified
as an impulse control disorder
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Is pathological gambling an addiction?
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Phenomenological similarities between gambling and substance
use problems led to Addiction Model of gambling
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Gambling is conceptualised as an addiction on the basis that
individuals repeatedly engage in a behaviour to achieve a
euphoric state
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Repetitive nature, loss of control, tolerance and withdrawal similar
to drug addiction
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However, some differences between gambling and substance
dependence
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Withdrawal symptoms following cessation of gambling are mild and
psychological (e.g., irritability, poor concentration, depressed mood)
Substances (unlike gambling) acts directly on the brain’s reward
pathways
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Epidemiology of problem gambling
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Among adolescents, 5% meet criteria for pathological gambling
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Among Australian adults, 2.1% prevalence (1% internationally)
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Males gamble more frequently and intensely than females
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For less severe cases, problem gambling may be transitory
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Several phases proposed by Robert Custer (1984):
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Winning phase – motivated by excitement
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Losing phase – attempt to recoup loses
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Desperation phase – engage in illegal activities to survive
Course of disorder influenced by comorbid psychological
disorders (e.g., 75% of gamblers suffer major depression)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Aetiology of pathological gambling
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Complex interaction of biological, psychological, sociocultural
factors
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Biological factors
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Serotonin – involved in specific impulsive behaviours and may play a
role
Dopamine – associated with impulsive-addictive behaviours, the D2
receptor gene may be involved
Norepinephrine – involved with arousal excitement, impulsive
behaviour, and sensation seeking. May be a causal factor
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Aetiology of pathological gambling
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Psychological factors
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Impulsivity – elevated levels associated with gambling
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Sensation seeking – relationship with gambling unclear
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Majority of pathological gamblers have at least 1 personality disorder
Learning
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Personality
Operant (instrumental) conditioning
Schedule of reinforcement – intermittent and unpredictable wins
produce behaviours that are highly resistant to extinction
Classical conditioning – gambling-related environmental cues paired
with arousal. Exposure to cues leads to urge to gamble
Cognitions
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Erroneous beliefs lead individuals to overestimate their chances of
winning
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
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Addictive behaviours
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Aetiology of pathological gambling
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Social and cultural factors
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Parental modelling of positive attitudes toward gambling
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Early negative childhood experiences
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Availability of gambling
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Social attitudes encouraging gambling
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Exposure model - as gambling opportunities increase within a
community, shifts in attitudes occur, and there will be more gambling
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Integrated pathways model (Blaszczynski & Nower, 2002) incorporates biological, personality, learning, cognitive, social and
cultural factors in differentiating three subgroups of problem
gamblers
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Behaviourally conditioned problem gamblers
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Emotionally vulnerable problem gamblers
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Biologically based problem gamblers
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Addictive behaviours
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Treatment of pathological gambling
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Gamblers’ Anonymous – self-help organisation, 12-step
recovery process derived from the principles and format of
Alcoholics Anonymous
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Behavioural and cognitive interventions
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Behavioural interventions
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Counter-condition the arousal (aversion therapy)
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Extinguish arousal to gambling cues (exposure therapy
Cognitive behavioural treatments
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Pharmacological interventions
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Challenging dysfunctional beliefs plus behavioral techniques
SSRIs, opioid antagonists, and mood stabilisers
The public health model
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Concerned with external societal determinants of gambling
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Reduce population-based risk factors, promote responsible gambling
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Summary
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Substance Use Disorders
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Diagnosis
Epidemiology
Aetiology
Treatment
Pathological Gambling
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Definition, Types of Gamblers, and Historical Approaches
Diagnostic Criteria
Is Pathological Gambling an Addiction?
Epidemiology
Aetiology
Treatment
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd