CHAPTER 4: Theories of Substance Abuse Etiology

1. CHAPTER 4:Theories of Substance Abuse Etiology Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • Understanding Theory • Overview of ATOD Theories • Moral Theory • Disease Theory • Genetic Theories • Behavioral Theories • Sociocultural Theories • An Integrated Approach

3. Understanding Theory • Each major theory is examined through the aspects of: • Initiation: Why people begin to use drugs • Continuation: Why people continue to use or abuse drugs • Addiction: Why some people escalate to dependence on drugs and others do not • Recovery: Why some people quit using drugs and others do not • Relapse: Why some people remain clean and/or sober and others do not

4. Moral Theory • Belief that those who cannot “hold” their liquor have a lack of willpower and are morally corrupt. • Aspects of Use Addressed by the Moral Theory • Initiation • Moral deficiencies (Personal needs) under this theory include: • A means to cope with painful and threatening emotions • Childhood factors • Self-regulation (Under-regulation or mis-regulation)

5. Moral Theory • Aspects of Use Addressed by the Moral Theory cont. • Continuation • Perceived rewards perpetuate the continued use of the drug • Use masks the underlying physical or emotional problems • Addiction • Sign of addiction is the absence of choice the user has over the drug use

6. Moral Theory • Aspects of Use Addressed by the Moral Theory cont. • Recovery • User must develop alternative rewards to replace the gratification of the drug experience • Relapse • Occurs when the needs and the lifestyle of the addict are not addressed when the drug use is ceased • Conclusion • Moral theory purports that addiction can be “cured”

7. Disease Theory • Belief that alcoholics suffer from an illness. • Theory began with Alcoholics Anonymous (AA) • Jellinek chart (Figure 4.1, page 102) • Aspects of Use Addressed by the Disease Theory • Initiation • This theory does not address “why” an individual chooses to drink, however Jellinek’s Pre-Alcoholic Phase describes use as being socially motivated • This theory postulates that individuals with the disease of addiction do not know they have it until they start using.

8. Disease Theory • Aspects of Use Addressed by the Disease Theory cont. • Continuation • Prodomal Phase: Individual uses alcohol to relieve physical or emotional pain, tension from job or family, or other stress • Crucial Phase: Visible changes occur • Addiction • Chronic Phase: Total loss of control/Loss of a choice to drink

9. Disease Theory • Aspects of Use Addressed by the Disease Theory cont. • Recovery • In this theory, an alcoholic or addict is never consider cured, only “in remission”, “recovering”, or a “nonpracticing” alcoholic or addict. • Recovery is focused on abstinence • Initial detoxification is followed by cognitive behavioral treatment • Relapse • Seen as failure, but also viewed as part of the recovery program • Conclusion • Having a disease removed the social stigma, making it easier for someone to seek treatment.

10. Genetic Theories • Studies demonstrated that genetic factors contributed between 50% - 60% of the variance of risk for alcoholism. • Dependence on illicit drugs estimates genetic heritability ranging from 45% - 79% • Aspects of Use Addressed by Genetic Theories • Initiation • More likely to be environmental and to co-occur with tobacco use • Other important factors: • History of parental drinking, smoking, or drug use • The degree of life stability • Personality traits

11. Genetic Theories • Aspects of Use Addressed by Genetic Theories cont. • Continuation • May involve a combination of social and biological factors • Antisocial behavior is also linked with substance abuse • Addiction • A variety of genetically influenced factors create a predisposition toward alcoholism • Protective factors • Risk factors

12. Genetic Theories • Aspects of Use Addressed by Genetic Theories cont. • Recovery • Addiction is a process. • Relapse • Heritability and molecular changes in individuals that lead to dependence, withdrawal and relapse: • Multiple neuronal pathways in the brain such as systems related to dopamine, serotonin, and opiate receptors • Can be induced by antagonists such as stress, environmental cues, and by the use of alcohol • High comorbidity rate with other psychiatric diagnoses • Concurrent use with other substances

13. Behavioral Theories • Three modes of behavioral control: • Pavlovian approach • Goal-directed action • Habit • Aspects of Use Addressed by the Behavioral Theory • Initiation • Social Learning Theory: Substance abuse is a function of positive norms, expectations, and modeling from family members and peers • May occur when an individual’s coping abilities are overwhelmed

14. Behavioral Theories • Aspects of Use Addressed by the Behavioral Theory cont. • Continuation • Generally seen as dependent on a positive experience or other reward • Chemicals themselves can act as reinforcers, ie.: Self-medicate • Addiction • Maintained by habit • Maintained by reinforcement

15. Behavioral Theories • Aspects of Use Addressed by the Behavioral Theory cont. • Recovery • Involves a behavior change • Replace rewards gained by continued use • Break the habit • Relapse • Situational antecedents • Cognitive behavior processes • Triggers • Conclusion • Addiction and substance abuse are seen as the result of learning patterns. • In treatment, goals are easily formulated because behaviors are easily observed and measured.

16. Sociocultural Theories • Environmental support for heavy drinking is an important sociological variable contributing to alcoholism. • Attitudes toward alcohol consumption and abuse vary form culture to culture • Aspects of Use Addressed by the Disease Theory • Initiation • Social factors can contribute to the introduction of the first use of a drug.

17. Sociocultural Theories • Aspects of Use Addressed by the Disease Theory cont. • Continuation • Positive initial experience • Existence of a drug-using peer group • Pressure to conform/”fit-in” • System Maintained/System Maintaining • Addiction • Confluence of sociological and cultural factors contribute to the proliferation of addiction. • Example: Cultures where alcohol has been present for several centuries and is an accepted part of daily life tend to have a lower rate of alcoholism than cultures where alcohol is a fairly recent phenomenon.

18. Sociocultural Theories • Aspects of Use Addressed by the Disease Theory cont. • Recovery • While replacing pro-drug socialized peer activities with non-using peers is an important goal in recovery, social and cultural tolerance may be a limiting factor in maintaining recovery. • Relapse • If broader systems are not addressed, chances of relapse are increased. • Conclusion • Several components of culture and the environment affect the likelihood of substance abuse.

19. Sociocultural Theories • Factors that appear to protect youngsters: • Bonding • Goal-direction • Monitoring from family, peers, religion, etc. • Participating in rewarding activities and prosocial behaviors • Selecting and emulating individuals who model temperance or shun substance use • Increased self-confidence and coping skills.

20. An Integrated Approach • Researchers are beginning to view addiction as more than a one-dimensional process that be explained by one single theory. • Researchers are beginning to postulate a model that is an amalgamation of genetics, environment, and learned behavior. • Integral Quadrant Model

21. Comparing Etiological Theories of Substance Abuse

22. Discussion • Is substance abuse an act caused by a weak moral character? • Is substance a disease? • Is substance abuse a result of heredity? • Is substance abuse a learned behavior? • Is substance abuse caused by environmental factors?