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Lecture Two: Addiction

Lecture Two: Addiction. Medical Model. CRAVING AND COMPULSION LOSS OF CONTROL CONSEQUENCES . Defining Addiction: The Experts Way In. DSM SAYS THERE ARE THREE COMPONENTS . DSM-IV-TR Criterion for Alcohol Dependence. Why do people abuse chemicals?.

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Lecture Two: Addiction

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  1. Lecture Two: Addiction Medical Model

  2. CRAVING AND COMPULSION LOSS OF CONTROL CONSEQUENCES Defining Addiction: The Experts Way In DSM SAYS THERE ARE THREE COMPONENTS

  3. DSM-IV-TR Criterion for Alcohol Dependence

  4. Why do people abuse chemicals? The simplest answer is because it feels good! But why then are we not all addicts?

  5. Is it not a choice? • What do folks think?

  6. Is it simple a choice? Is it simple a choice

  7. Physical reward potential Increased sense of pleasure Decreased discomfort Thus I use again and again • Pleasure center is not one a single center • Pleasure centers across brain systems • Motivated to seek further stimulation

  8. Social Learning Component • We learn how to use drugs and substances • In order to maximize their potential both physically and psychologically. Individual Expectation of Drug/Alcohol / Substance

  9. 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

  10. Individual Life Goals Present Past Future • It’s Important to remember that chemical abuse patterns are not fixed • Moreover, no one sets out to become addicted

  11. Medical model of addiction or Disease Model

  12. 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.

  13. 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

  14. Jellinek’s Four Stage Model Prealcoholic Phase Prodromal Phase First Blackouts; preoccupation with use, development of guilt PROGRESSIVECOURSE LEADING TO DEATH Alcohol used for relief from social tension Crucial Phase Chronic Phase Loss of tolerance; obsessive drinking, alcoholic tremors, drinking with social inferiors Loss of control; Physically dependent

  15. Jellinek’s Additions • Later classified different types of alcoholics • One hallmark of the alcoholic – they can’t predict how much they will drink • His legacy – something worth studying • Removes prejudices of the immoral alcoholic • Wasn’t about will power was a “disease”

  16. 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

  17. 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

  18. 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

  19. 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 • Women were also found to fit Type II • Low Levels of MAO

  20. 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

  21. 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

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