LECTURE THREE The Medical Model DSM (2013) – 5 Alcohol Use Disorder Mild presence of 2 to 3 symptoms Moderate presence of 4 to 5 symptoms Severe.

LECTURE THREE The Medical Model

DSM (2013) – 5 Alcohol Use Disorder

Mild presence of 2 to 3 symptoms

Moderate presence of 4 to 5 symptoms

Severe presence of 6 or more

The 11 Symptoms1. Alcohol is often taken in larger amounts or over a longer period than was intended

2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use

3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

4. Craving, or a strong desire or urge to use alcohol

5. Recurrent alcohol use resulting in a failure to fulfill major obligations at work, school, or home

The 11 Symptoms (cont.)6. Continued use despite having recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use

8. Recurrent alcohol use in situations in which it is physically hazardous

9. Alcohol use is continued despite the knowledge of having recurrent physical/psychological problems likely to be caused by alcohol

The 11 Symptoms (cont.)10. Tolerance a) need for increased amounts to achieve desired effect, or b) a markedly diminished effect with continued use of the same amount of alcohol

11. Withdrawal, as manifested by either of the following a) the characteristic withdrawal syndrome for alcohol, b) alcohol (or closely related substance) is taken to relieve or avoid withdrawal symptoms

Exploring the Medical Model….

AND IT’S ROOTS

LET’S FIRST START WITH THE WHY?

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

Thus I use again and again

Pleasure center is not one a single center

Pleasure center across brain systems

Motivated to seek further stimulation

Social Learning Component

Individual Expecta

tion of

Drug/Alco

hol / Substa

nce

Individual Expecta

tion of

Drug/Alco

hol / Substa

nce

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

Present Future

Past

• It’s Important to remember that chemical abuse patterns are not fixed

• Moreover, no one sets out to become addicted

MEDICAL MODEL OF ADDICTIONor 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

Prodromal Phase

Crucial Phase Chronic Phase

Alcohol used for relief from social tension

First Blackouts; preoccupation with use, development of guilt

Loss of control; Physically dependent

Loss of tolerance; obsessive drinking, alcoholic tremors, drinking with social inferiors

PROGRESSI

VEE

COURSE

LEADING

TO DEATH

PROGRESSI

VEE

COURSE

LEADING

TO DEATH

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

Later studies confirmed findings

10% of sample became alcoholics

Low Levels of MAO

Neuro-Biological Processes, Dopamine, and Drug Addiction

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 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