Assessment and Treatment of Addictive Behaviors Carl W. Lejuez, PhD

1. Assessment and Treatment of Addictive BehaviorsCarl W. Lejuez, PhD Lecture 1 Introduction to Addiction

2. What is Addiction ? • Defined by tolerance, withdrawal, & craving • Involves a person's heightened and habituated need for a substance (or engagement in a particular behavior) • It causes intense suffering that results from discontinuation of its use • Addicted individuals will sacrifice all (to the point of self-destruction) for their addiction.

3. Types of Addictions • Substance Use addictions • Alcohol • Drugs (Prescription and Illicit) • Nicotine • Non-Substance Use addictions • Gambling • Eating Disorders

4. History of Drug Use • Why did people first start using drugs? • Levinthal suggests curiosity or mere chance led to the ingestion of psychoactive substances • Early use often tied to religious ceremony. • Other drugs identified for medicinal purposes

5. History of Drug Use: Ancient • Drugs in Early Times • 5000 B.C. (7000 years ago!) • Evidence that the Sumerians used opium • 3500 B.C. • Earliest record of the production of alcohol in Egypt • 350 B.C., Proverbs, 31:6-7 • “Give strong drink to him who is perishing, and wine to those in bitter distress; let them drink and forget their poverty, and remember their misery no more”

6. History of Drug Use in US:17th -19th Centuries • Early colonial US • High level of alcohol use, but limited problems • Use was common, misuse not tolerated (Peele, 1989) • 18th and 19th century • Industrial Revolution • Breakdown of social control networks led to misuse of alcohol • Birth of Washingtonians: Reformed drinkers pre AA • Most narcotics were legal • Use of morphine for medical purposes

7. History of Drug Use in US:19th Century • 1884 Freud supports cocaine use (Freud is in Europe, but has influence in US) • Writes an article on the safety and potential therapeutic benefits of cocaine • 1898 Heroin introduced as a safe and legal alternative for morphine

9. History of Drug Use in the US: 20th Century • 1903 Cocaine is removed from Coca-Cola, and replaced with Caffeine. • 1914 Harrison Act made narcotics illegal • Due in part to a shift in populations using narcotics from largely middle-class to urban, minority, and lower-class users of heroin • These developments were supported by the American Medical Association

10. History of Drug Use in the US: 20th Century • 1920 Volstead Act makes alcohol illegal • Prohibition • Resurgence of the disease model of addiction • Rise of AA and related groups for other addictions • Volstead act is repealed in 1933 • 1938 Albert Hoffman synthesizes LSD, five years after accidentally ingesting a small amount of a similar compound

11. History of Drug Use in the US: 20th Century • 1965-1967 “Summer of Love” in Haight Ashbury, San Francisco

12. History of Drug Use in the US: 20th Century • 1971 President Nixon begins the “War on Drugs • Over $200,000,000,000 has been spent to control American drug use. • The amount of drugs smuggled into the country, and the amount produced inside the country, continues to increase • 1977 MDMA, or Ecstasy, becomes available as a recreational drug. It remains legal until 1985

13. History of Drug Use in the US: 20th Century • 1985 Crack, a cheap, smokable form of cocaine, is introduced • Low cost greatly expands the number of cocaine users • 1995 OxyContin emerges as a effective pain killer • High risk of dependence

14. History of Drug Use in the US: 20th Century • Today • Each year in the United States: • Approximately 400,000 deaths are attributed to cigarette smoking (National Cancer Institute, 1994) • 110,000 deaths are attributed to alcohol (National Institute of Alcohol Abuse and Alcoholism [NIAAA], 2002) • 20,000 deaths are attributed to illicit drug use (The White House Office of National Drug Control Policy [ONDCP], 2001). • In 2000, American’s spent an $63 billion on illicit drugs.

15. Causes of Addiction • Disease Model • Foundation for AA and other related groups • Personality Factors • Certain personality traits increase the likelihood of drug use and addiction • Environmental • Drug use is a learned coping strategy in response to past learning and current life events • Diathesis/Stress Model • Genetic predisposition combined with environmental factors

16. Causes of Addiction:Disease Model • Alcoholism and other addictions represent diseases for which a certain proportion of the population is genetically predisposed • Developed by Dr. Benjamin Rush, late 1700’s • Scientific credence in 1960 • Jellinek’s “Disease Concept of Alcoholism” • Originally rejected by AMA, but now accepted • Framework for AA and other 12 step groups

17. Elements of the Disease Model • Addiction is a progressive, chronic disease. • Addiction entails a “loss of control” over substance use. • Part of the disease is a denial of the effects substance use is having on one’s life. • The disease can not be cured. It can be managed by abstaining from substance use.

18. Causes of Addiction:Personality • Particular personality traits predispose one to addiction • Sensation seeking • The seeking of novel experiences and sensations • Impulsivity • An inability to delay gratification • The preference of immediate small rewards over large, but more delayed rewards • Decision-making without consideration of potential negative consequences

19. Support for Personality Theory of Drug Abuse • Why is this relevant? • If we can identify factors that place individuals at an increased risk for drug use/abuse, then we may be able to target these groups for prevention • Treatment based on this theory has yet to be developed in spite of evidence from research

20. Causes of Addiction:Environmental • Behavioral • Classical Conditioning • Particular stimuli related to the addictive behavior become paired with the behavior • Further contact with such stimuli produce conditioned response • Operant Conditioning • Past addictive behavior produced positive consequences • Future use in presence of discriminative stimuli • Addictive behavior is more rewarding than alternatives • Expectancies • Self-medication

21. Support for Environmental Explanations of Addiction • Untreated Heroin recovery (Robins, 1975) • Research on 451 Vietnam veterans who had been addicted to narcotics in during the war • Only 14 percent became re-addicted after their return • Environmental cues for addiction no longer active • Heroin overdose • In the presence of heroin cues, body has compensatory reaction (Falk, 1983) • If drug taken out of typical environment, body does not prepare for drug that comes • If no drug taken in typical environment, body prepares for drug that never comes

22. Causes of Addiction:Diathesis/Stress Model Certain people, due to a variety of factors, may be predisposed (diathesis) to developing an addiction to something, be it alcohol, heroin, gambling, sex, shopping, or on-line computer services. They could go through their entire lives never developing any kind of addiction. On the other hand, if the right stressor, or combination of stressors, affects the person at a critical time, the person may be more inclined to develop an addiction.