©2010 McGraw-Hill Higher Education. All rights reserved. Chapter 2 Why Do People Abuse Drugs? A Better Understanding of Models and Theories of Drug Dependence and Addiction
Dec 24, 2015
©2010 McGraw-Hill Higher Education. All rights reserved.
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 boredomAffect (feeling) regulation
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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
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Models
1. Disease model2. Genetic model -adoption studies/twin studies3. Self-medication (Khantzian, 1985)4. Personality traits5. Personality disorders6. Mood & Affect disorders7. Family model8. Poor self-concept9. Psycho-social social learning10. Socio-cultural
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Models of Substance Abuse
General acceptance of multiple causes, a matrix of both Genetic & Environmental factors.
No one model explains all substance abuse.
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Disease Model
1957 AMA declares Alcoholism a disease based on 3 factors
– Known etiology (cause)– Symptoms get worse over time– Known outcomes
12 step approach based on the disease model– 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
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Genetic Model
Adoption studies – Sons of alcoholics – 4 times more likely to be
alcoholic – Daughters of alcoholic fathers – have more somatic
anxiety and frequent physical complaints Twin studies
– 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
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Models of Substance Abuse
1. Personality
2. Tension Reduction models
3. Psychoanalytic model
4. Family model
5. Psychosocial models – social learning theory
6. Sociocultural models
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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, quick-
tempered, fickle, extravagant
Models of Abuse
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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
Models of Abuse
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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?
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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
Models of Abuse
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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
Models of Abuse
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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.)
Models of Abuse
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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
Models of Abuse
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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
Theories of Drug Use
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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
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Personality Theory
Specific personality traits of alcoholics/addicts Impulsivity/”dis”-inhibition Risk taking behavior Personality disorders – narcissism, borderline
– strong correlation with substance abuse
Theories of Drug Use
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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
Theories of Drug Use
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Personality Traits of Addicts/Alcoholics
High emotionality Anxiety & over
reactivity Inability to express
anger adequately Immaturity in
interpersonal relationships
Ambivalence to authority
Anger over dependence
Low self-esteem with grandiose behavior
Perfectionism compulsiveness
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Personality Traits cont’d
Feelings of isolation Depression Sex role confusion –
sexual immaturity Dependence in
interpersonal relationships
Hostility Rigidity – inability to
adapt to changing circumstances
Simplistic black and white thinking
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Optimism and Pessimism
OPTIMISM
Very temporary
Specific
External
PESSIMISM
Permanent
Pervasive
Personalized
Source: Learned Optimism, by Martin E.P. Seligman, Ph.D., Pocket Books, 1992
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Adolescent Drug Abuse
Paul Robinson in “Beyond Drug Education” emphasized:– Controlling destructive impulses is the
primary means of controlling drug abuse for adolescentsLearning to PAUSE before acting is a
learnable behavioral change