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LECTURE TWO: ADDICTION Medical Model Defining Addiction: The Experts Way In DSM SAYS THERE ARE THREE COMPONENTS CRAVING AND COMPULSION LOSS OF CONTROL CONSEQUENCES DSM-IV-TR Criterion for Alcohol Dependence Why do people abuse chemicals? The simplest answer is because it feels good! But why then are we not all addicts? Is it not a choice? What do folks think? Is it simple a choice? Is it simple a choice Physical reward potential Increased sense of pleasure Decreased discomfort Pleasure center is not one a single center Pleasure centers across brain systems Motivated to seek further stimulation 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. 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 Past Present 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) a psycho-biomedical process 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 (by the AMA) Proposed alcoholism to be a progressive / predictable disorder Jellinek’s Four Stage Model Prealcoholic Phase Alcohol used for relief from social tension Crucial Phase Loss of control; Physically dependent Prodromal Phase First Blackouts; preoccupation with use, development of guilt Chronic Phase Loss of tolerance; obsessive drinking, alcoholic tremors, drinking with social inferiors 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” 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 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 20% chance of becoming alcoholic regardless of SES Later studies confirmed findings Women were also found to fit Type II 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 biotransform 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