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©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
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©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.

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Page 1: ©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.

©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

Page 2: ©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.

©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

Page 3: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 4: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 5: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

Models of Substance Abuse

General acceptance of multiple causes, a matrix of both Genetic & Environmental factors.

No one model explains all substance abuse.

Page 6: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 7: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 8: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 9: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 10: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 11: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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?

Page 12: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 13: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 14: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 15: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 16: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 17: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 18: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 19: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 20: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 21: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 22: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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

Page 23: ©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.

©2010 McGraw-Hill Higher Education. All rights reserved.

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