Addiction: What is it or what is it Not Lecture Three Addiction: What is it or what is it Not

Short Group Exercise Your row’s task is to create a definition of addiction and then present it to the class

Looking at the MAST

Let’s Look at the MAST Score one point if you answered the following No Yes 7 through 22: Yes

Scores mean? 0 – 2 no apparent problem 3 – 5 Early or Middle Problem drinker 6 or more Problem Drinker

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

Is it not a choice? What do folks think?

Is it simple a choice?

Physical reward potential Increased sense of pleasure Decreased discomfort Thus I use again and again

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

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 Past Future It’s Important to remember that chemical abuse patterns are not fixed Moreover, no one sets out to become addicted

Medical model of addiction or 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) psycho-biomedical processes 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 Proposed alcoholism to be a progressive / predictable disorder

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

Genetic Inheritance Theories More or Less sensitive to alcohol effects – (reward pathway); (like dislike substance) Decision making (frontal cortex) Make it harder to quit Affect withdrawal syndrome Different studies suggest that genes account for 20% to 50% 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 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