Download B. Models of Alcohol/Drug Dependence and Addiction

Chapter 1: Etiology: A Better Understanding of Models of
Drug Dependence and Addiction
Key Teaching Points

No one model explains all aspects of addiction.
Ask Students: Which model described in Chapter 1, best explains the
progression of Alcoholism and drug addiction?
Explain: Quote the philosopher Mencken:
“The solution to a complex problem, that is simple, is usually wrong.”
“The Just Say No” approach is an example of a generalized, simple solution,
that doesn’t address the problem and the demand for alcohol/drugs.

DRUGS serve the individual in many varied ways:
a.
Altering consciousness
b.
Regulating mood (alleviate depression, boredom, etc.)
c.
Relieving stress
d.
Stimulating thought
e.
Disconnecting and or/connecting
f.
And a variety of other reasons.
Exercise: Have the students rank these purposes and have them explain.
Encourage personal examples and disclosure for greater cohesion of the
class, and for later exploration of personal biases.

The 3 criteria that classify Alcoholism as a disease are
1. Known etiology (cause)
2. The symptoms get worse over time
3. Alcoholism has known outcomes (AMA, 1957)
Class Activity: Is Alcoholism/Drug Addiction a disease?
Have class express opinions and then have them prepare a debate on the
issue.

Alcohol/Drugs are used to “Alter States of Consciousness”
Despite “supply side” efforts to eradicate drug use in America, humans will
always seek out ways to alter their consciousness; it is an “innate drive” much
like our hunger/thirst drive for survival, and sexual drive that leads to
procreation.
Ask students: “Do you think people will ever stop using alcohol/drugs as a
quick and easy way to alter consciousness?” Explain and give examples for
various developmental stages. e.g. Twirling by young children, day
dreaming in school, roller coasters, scary movies, etc.

We will never do away with drugs, because people will always use
drugs/alcohol to alter their state of consciousness.

Alcohol/Drug use is a “passive activity. All you have to do is take the drug in
and wait for the desired effect.
You just take the drug in – smoke, snort, inject, swallow, or put in an orifice,
and wait for the desired effect. It does not require much work, other than
obtaining the drug.
Whereas, other states of altered consciousness, and are more active –
requiring practice, study, increasing knowledge, and constant trial and error
(e.g. learning a sport, gardening, cooking, playing chess, studying this text,
etc.)

The Developmental-Genetic Model of Alcoholism described by Devors (1994)
describes Alcoholism as a “group of illnesses”
“Alcoholism must no longer be thought of as a single disease with a cause that
is either genetic or environmental but as a group of illnesses in which the
influences of genes and the environment ebb and flow over the course of the
at-risk lifetime.”
Ask Students: Describe the importance of twin studies and adoption studies
as affirming the Genetic model.

Cloningers model, describes the use of alcohol/drugs for
1. Harm avoidance
2. Reward dependent
3. Novelty seeking
Ask students: Is there an “Addictive Personality”?
Have you ever known someone who has an addictive personality?

Khantazian’s case that drug use is not a random phenomenon, but a
purposeful attempt by the user to assuage painful affective states.
Ask Students: Do you think drug use is purposeful or chosen?
What drugs do you think are used to medicate what emotional states?
e.g. Alcoholism for depression.
Marijuana for boredom and relaxation.
At low doses, and occasional use, drugs can be used to change mood, view
one’s world differently, or jus to relax. However, continued escalation in
frequency of use, and increase in dose, can lead to significant negative
consequences, and problems of abuse and dependence.

Personality Disorders create more significant “maladaptive behaviors” in
relationships and work, than personality traits.
Explain: You might want to skip ahead to chapter 10, and explain that
personality disorders result in significant impairment in interpersonal
relationships, and disruption of effective job performance, and life tasks.

The two personality disorders most highly correlated with substance abuse
problems are antisocial and borderline personality disorders.

Dependent personality disorder and narcissistic personality disorders are
also correlated with substance abuse problems but not as strongly as
antisocial and borderline.

The risk, the adrenalin rush, are secondary reinforces of alcohol/drug abuse
and addiction.
Ask students: Do they remember “a close call” and how relieved that felt
afterwards? Have students describe these close calls, and the rush
afterwards.
Compare that to the “euphoric recall” of alcohol/drug escapades.
Ask Students: To define optimism and pessimism and rate themselves on
overall optimism, with explanations. Remind them that even a little bit of
pessimism can destroy optimistic thinking and actions.
Describe: The stages of stress and alcoholism charts developed for the
Gitlow material.
To Do: Have the students describe similar cycles of alcohol/drug use.

Review the remaining models in the chapter - see chapter outline

Ask the discussion questions for each case described at the end of this
chapter.
CHAPTER OUTLINE
A. Why Do People Abuse Alcohol/Drugs?
1. Many reasons for drug/alcohol use
2. Primary reason or drive – innate drive to alter consciousness – much like
our innate drive of hunger, thirst and sex
3. Drug use is a passive activity – you take the drug in, and wait for the
effect
B. Models of Alcohol/Drug Dependence and Addiction
1. Disease concept of alcoholism – defined by AMA as a disease in 1957
based on three criteria – known cause (etiology), progressive
symptoms and known outcome.
2. Developmental-Genetic Model – Devor (1994) alcoholism thought of as
“a group of illnesses in which the influences of genes and the environment
ebb and flow over the course of the at-risk life-time.”
3. Genetic Model – adoption studies and twin studies confirm a genetic
model.
4. Personality – no such thing as an addictive personality, more appropriate
to talk about “psychological vulnerability”.
5. Self-Medication Motive – Khantzian (1985) – drug use as a purposeful
attempt by the user to assuage painful affective states and to manage
psychological problems and disorders.
6. Personality Traits – many personality traits are associated with substance
abuse problems (see section of chapter).
7. Personality Disorders – antisocial and borderline personality disorder are
most highly correlated with substance abuse problems, also to a lesser
extent – narcissistic and dependent personality disorders.
8. Risk Taking Behavior – Impulsivity and disinhibition are correlated with
substance abuse problems.
9. Mood and Feeling (Affect) Disorders – depression and bipolar disorder
make one more vulnerable to substance abuse.
10. Feelings and Attitudes - that contribute to substance Abuse include:
hopelessness, pessimism, poor future orientation.
11. Tension Reduction Models – alcohol/drugs used to reduce stress, tension
12. Conditioning and Substance Abuse
13. Attention Deficit Hyperactivity Disorder (ADHD)
14. Psychoanalytic Models
15. Psychoanalytic Meaning – e.g. power, self-destruction, seduction, and
sexuality.
16. Family models – self-concept, adolescence.
17. Psychosocial Models – Social Learning Theory (SLT)
18. Sociocultural Models