Psych 2520 Exam 1
Theory as a roadmap
"a theory is always a map that is in the process of being filled in with greater detail. We do not so much ask whether it is true, but whether it is helpful" (Steffire & Burks, p. 9)
We have come to understand addiction in one of three ways
(1) immoral conduct, (2) disease (3) maladaptive behavior.
Post-Prohibition and the Medicalization of Addiction
*-Prohibition was unsuccessful in limiting alcohol consumption, only moderately successful in reducing drinking* -*Prohibitionists believed that anyone could become an alcoholic*, whereas AA members identified themselves as compulsive drinkers who had a unique constitution that prevented them from drinking "normally." -AA's adoption of the allergy theory -Due to the effects of the 1915 Harrison Narcotic Act and America's involvement in World War II and then the Vietnam War, drug addiction remained a focus of scientific inquiry. Prisons had become overcrowded with convicted narcotic users in the 1920s, -The civil rights movement in the United States and the counterculture of the 1960s represented a slight shift in tide toward drug addiction and also showcased a greater variety of addictive substances, namely, hallucinogens and marijuana, and in the 1980s, cocaine -They also were branded as "liars" who were "in denial" about their addiction, and so treatment approaches necessarily included confrontation to "break through" their strong defense mechanisms. ....Psychotherapy ("repressed feelings" were thought to be the cause of addiction)
Historical Conceptions of Addiction (U.S.)
*Colonial Period* -alcohol was seen as everyday life -used for medicinal uses -water has not always been clean...beer and wine has always been safe to drink *Mid to late 1700s* -people start to become concerned about drunkenness because of the problems it causes (depression, jaundice caused from liver disease) -alcoholism starts to be thought of as a disease state -drinking begins to be perceived as a moral issue ..."alcohol problems were the result of evil spirits" *Late 1800s* -excessive drinking referred to as a "treatable disease" ..."alcohol problems were the result of evil spirits"
How do these 3 broad perspectives line up?
*Immoral/Sin* Cause: Immoral behavior Significant Influences: Individual's free will View of person with addiction: They have chosen misbehavior Treatment: Punishment-based approaches (jail, fines) "War on Drugs" *Disease* Cause: Condition/Disease Significant Influences: Biological View of person with addiction: Victims of a disease Treatment: Medical-based approaches (medication) *Maladaptive Behavior* Cause: Learned behavior Significant Influences: Societal, environmental, biological View of person with addiction: Victims of living and learning conditions (ex: high crime areas, childhood trauma) Treatment: Public health and psychological interventions (contingency management, relapse prevention)
From Revising the Language of Addiction
*Instead of Abuser, Addict...* -use "person-first" language -use "suffers from addiction or SUD *Instead of drug...* -use "medication" or a "non-medically used psychoactive substance" to avoid ambiguity *Instead of clean, dirty...* -use proper medical terms for positive or negative test results for substance use *Instead of lapse, relapse, slip...* -use morally neutral terms like "resumed" or experienced "recurrence" of symptoms
Tolerance and Withdrawal - Video
*Tolerance:* you get used to a drug so that you need more of it in order to achieve the same effect -neurons come from the VTA (sending dopamine) ->>postsynaptic neuron has receptors for the dopamine to get taken up, which is how we experience the euphoria -drugs can alter your brain chemistry (compared to just hugging someone) ->>>after a while the brain says "I need to calm down" and shuts down some of those receptors *Withdrawal* -without the drug (ex: cocaine), you tend to feel depressed, highly anxious, sweating, headaches ...at this point, you aren't even aiming for euphoria anymore, you are aiming to feel normal at this point
susceptibility vs. exposure constructions
*susceptibility variant:* emphasizes that genetic factors play an important role in the development of substance dependence...these factors influence the individual's vulnerability to the disorders *exposure variant:* emphasizes that chemicals and their actions on the brain are the primary causes of addiction, asserts that addiction is a brain disease
receptor sites
*target areas* for the neurotransmitter molecule at the postsynaptic terminals.
Addiction as a Disease
-"A primary, chronic disease" -> American Society of Addiction Medicine -The underlying addiction causes the substance use -If you don't have the disease, alcohol/drugs will not become a problem if you use (no matter how much you use) -Cause isn't clearly articulated, assumed to be genetic (dispositional disease) -Central feature: loss of control (covered in chapter 2) -Since it's a disease, people should receive compassionate, medical care
Evidence in support of treatment/prevention
-A major problem in U.S. drug control policy today is the lack of awareness, among both the general public and political leaders, that comprehensive and competently administered prevention programming and addiction treatment are effective in addressing problematic substance use; that is, prevention and treatment do "work." -Stated in another way, if youth are influenced to perceive that substance use is uncommon (not prevalent) and is socially unacceptable among their peers, they are less likely to initiate or continue substance use. -Thus, *a major challenge facing the addictions field is implementing evidence-based practices into in-service and formal training programs* needed to prepare highly competent practitioners for the future.
Take-home points
-Addiction is a complex phenomenon -A number of historical perspectives and experiences influence how we understand addiction today -There are treatments that work (not always put into place) -Language can be stigmatizing
Current Views: Moral Affliction...Think War on Drugs
-Criminal, moral affliction still prominent in some circles, despite lack of evidence -"Hybrid medical-moral affliction" view (p.21) "War on Drugs" 1986 Anti-Drug Abuse Act (Reagan) -Increase $ to fight drugs (Law enforcement, zero tolerance) -Decrease $ for treatment & research purposes Zero tolerance policies, drug courts *Effects of these changes are still present
Laboratory Experiments
-For more than 30 years, evidence has shown that chronic alcoholics (including those who have previously experienced alcohol withdrawal sickness) can drink in a controlled manner in laboratory settings -A common counterargument to these findings is that the drinking occurred in artificial or unnatural drinking environments
Addiction as a Primary Disease
-In primary care medicine, addiction, especially alcoholism, is still described as a "primary disease" - that is, it is not the result of another condition. -This view is contrary to popular conceptions of addiction, especially of alcoholism. To take alcoholism as an example, many laypeople (even those who view alcoholism as a disease) feel that alcoholism results from abusive drinking, which in turn stems from irresponsibility, stress, or emotional problems.
An Alternative Model: Maturing Out
-In the 1980s, Peele (1985) advanced the concept known as maturing out (still used today) to explain how many alcoholics and addicts give up substance abuse without the benefit of treatment or self-help programs -Evidence also shows that the alcohol consumption of young adults tends to follow the process of maturing out. Similar to heroin, the process seems to be conditional on a number of individual characteristics and social variables.
The Neuroscience of Addiction - Dr. Anna Lembke - Video
-Lembke was one of the first to sound the alarm on the opioid epidemic (Professor of Psychiatry and Behavioral Sciences) young man, about 19 years old "sunk cost fallacy" -played video games extensively, eventually got so depressed/anxious, started to make plans to end his life ->>>relationship between the video games and his feeling of wanting end his life ("feels video games is his only rescue from his purposeless existence") Lembke's Hypothesis: she believes that the video games that caused him to become depressed/anxious -> the neuroscience behind it: 1. Discovery of neurotransmitter dopamine 2. Discovery that the same part of the brain also processes pain (pain and pleasure work like a balance/teeter totter) The fundamental problem: -we live in an overly abundant world of pleasurable substances, so we need to avoid these potent things NOTE: the pleasure/pain teeter totter wants to STAY LEVEL (homeostasis) -after you eat a piece of chocolate downregulation occurs, "gremlins" jump on the pain side (opponent process reaction) is experienced, this can be represented by grabbing another piece of chocolate What happens in the brain when people become addicted? -things that are addictive release A LOT of dopamine and very QUICKLY -a big tip to pleasure requires a big tip to pain (COME-DOWN) ...with repeated exposure: the response to pleasure gets weaker and shorter and the opponent-process response gets stronger and longer (this is why we need more and more over time with repeated use) so...Lembke has the boy abstain from all screens for 1 month -> for the first 2 weeks, he will feel worse than better because the universal symptoms of withdrawal are irritability, insomnia, anxiety, dysphoria, craving for the drug (balance will be weighted to the side of pain) ***Results***: -he abstained, it worked, he is better now and created barriers in order to limit his video game use
Disease Models is PLURAL
-Note that models is plural, there are multiple disease models -In general, they focus on different aspects of the process *so they are mostly "complementary" rather than in conflict with another Example: Susceptibility Model vs. Exposure Model
Addiction as Maladaptive Behavior (cont.)
-Prevention and treatment usually use models focused on *learning theories* -Help with changing behavior, environment, etc. *usually at multiple levels (family involvement, policy work, etc.) *we have evidence-based treatment and prevention that works, not always translated into practice
Alcohol Use Disorder (AUD); Substance Use Disorder (SUD)
-Prior to DSM-5, terms "Alcohol/Drug Abuse" vs. "Alcohol/Drug Dependence" were used -Abuse focused on *negative consequences* of heavy drinking -Dependence was signaled by tolerance, withdrawal, and impaired control -In DSM-5, 11 symptoms and severity gradients (2 of 11=mild AUD) *not all individuals who meet diagnostic criteria share overlapping symptoms *many different combinations possible on a scale from mild, moderate, to severe List of symptoms: -use in hazardous situations -failure to fulfill major role responsibilities -social or interpersonal problems -tolerance -withdrawal -impaired control -attempts or desire to "cut down" -time spent (obtaining, using, recovering) -important activities given up -use despite physical or psychological problems -craving
Temperance Movement and Prohibition
-The emphasis on moderation gave way to the necessity of abstinence for all citizens*. Thus, the temperance movement became a prohibitionist movement, and increasingly habitual drunkenness or intemperance was seen as immoral conduct. -*Employers stopped supplying alcohol to their employees* on the job. Politicians were more restrained in their relations with alcohol producers and distributors. -It was not until the late 1800s that the Temperance movement experienced resurgence, most notably under the *leadership of women*, many of whom had experienced the debilitating effects (e.g., loss of family income and home; domestic violence) of the excessive drinking of their husbands and other male family members. -social contagion -The federal ban on all production, transportation, and sale of "intoxicating liquors" had a profound effect on how addiction was—and still is—understood and treated. Even though prohibitionists located the culprit of alcohol addiction in its "poisonous" beverage, the person who "allowed" himself or herself to become victim to excessive alcohol consumption (whether it was beer, wine, or distilled alcohol) still was viewed by the majority of the populace as morally depraved and deserving punishment
Current Views
-Throughout U.S. history, addiction to alcohol or other drugs has consistently been viewed as a "hybrid medical-moral affliction" -definition of addiction as "a primary, chronic disease" (www.asam.org), advances in neurobiology and biochemistry, and findings from sophisticated behavioral and social science research -"fight drugs" and implement a "zero tolerance" policy. This moralistic and punitive view of addiction still guides alcohol and drug control policies today. For instance, drug courts "sentence" offenders to "treatment": Driving while intoxicated offenders are required to participate in treatment and/or attend AA meetings -developmental learning model of addiction that highlights the brain's neuroplasticity as part of the process of learning—the learning of addiction and the learning of recovery. His model is discussed briefly in a later section of this chapter,
Concerns about Genetic Determinism
-Too often, the *magnitude of the genetic influence is exaggerated*, or relevant environmental factors are unduly minimized, often as a result of ignorance about the interactive nature of each -This lack of understanding also has fueled the mistaken belief in "genetic determinism." -GENES ARE NOT DETERMINISTIC FACTORS OF ADDICTION!
Exposure Models
-chemicals and the chemical influence on the brain causes addiction -thinks of addiction as a "Brain Disease" (drugs CHANGE the brain)
A theory....
-coherent and consistent body of knowledge -for addiction, theories can be useful to attempt to understand and explain human behavior and how/why/when change occurs -tentative and provisional -we evaluate theories in terms of whether they are useful (rather than if they are "true") -theory guides observation - observation guides theory development
Susceptibility Models
-genetic factors important -they influence one's vulnerability to addiction
The Neurobiological Basis for Development of Tolerance
-in a chronic addictive state, *dopamine levels gradually decrease over time*, making the mesolimbic system less sensitive and thereby producing deficient rewards.
Philosophical Foundations of Public Health
-medical science is viewed as the means to best promote and preserve the health of the population. ...An alternative model arises from a collectivist social philosophy that is more holistic and ecological and points to multilevel intervention activities
Disease Models - An overview
-tend to be associated with decreased stigma -abstinence is a key feature -addiction viewed as a chronic condition -these models took main stage across many treatment communities and programs *AA/NA *Rehabilitation centers
Cell Activity of the Human Brain
-there are approximately 86 billion neurons in the human brain
Overview of evidence
-there are effective prevention and treatment approaches that are cost-effective -school-based approaches reduce use *not "knowledge" programs or "just say no", rather ones that focus on social components of risks and skills building -identifying effective treatments has also been a focus (NIAAA, NIDA) Ex: motivational enhancement approaches, contingency management -Federal funding still focuses on law enforcement (top priority), then treatment, research, prevention, and so on Bottom line: stuff works, but it's not often implemented in practice
two clinical features of substance dependence
-tolerance -withdrawal
Reward Pathway in the Brain - Video
-when you first experience pleasure, your brain releases dopamine -dopamine is produced in ventral tegmental area -> goes to a lot of different parts of the brain (amygdala (emotion), nucleus accumbens (motor functions), prefrontal cortex (attention, planning), and hippocampus (memory formation) ->these areas uptake the dopamine and you feel a sense of happiness/euphoria *ex: piece of cake* amygdala: "this piece of cake is so good I'm really happy right now" hippocampus: "well let's remember what type of cake this is/what restaurant I'm at" nucleus accumbens: "well lets use our hand to grab the fork to take another bite" -different stimuli activate this reward circuit to a greater degree than others (ex: different drugs) as dopamine goes up, serotonin goes down (this is why drugs can be problematic, which is why you are less likely to be satiated/content) rat studies show us how addiction takes over our mind
Attributes and Functions of a Good Theory
1. Explains related set of observations 2. Coherent and cohesive 3. Comprehensible 4. Explicit 5. Involves no more concepts or elements that are necessary 6. Comprehensive 7. Generates testable predictions 8. Not contradicted by empirical evidence
the American Association for the Cure of Inebriates (AACI) - Four principles
1. Intemperance is a disease. 2. It is curable in the same sense that other diseases are. 3. Its primary cause is a constitutional susceptibility to the alcoholic impression. 4. This constitutional tendency may be either inherited or acquired.
Colonial Period & Reformation
1607-1776 -alcohol was used for many things -was not of main concern -some employers even supplied workers with alcohol mid to late 1700s -starts to become more disease oriented -Benjamin Rush and Thomas Trotter contributed to the re-defining of habitual drunkenness -"the habit of drunkenness" was a "disease of the mind," similar to delirium and mania. (Trotter) Late 1800s -excessive drinking was specifically referred to as a treatable disease
Temperance Movement & Prohibition Period
1808-1826: Temperance Societies/groups formed -focused on moderation 1830s Temperance Societies grew -people starting to pledge abstinence -now prohibitionist movement -alcohol, opium, morphine all seen as addictive poisons Late 1800s Reinvioration and Temperance (movement led by women) -strong moral and religious basis -driven by negative effects of heavy drinking in communities (ex: violence at home, loss of income) alcohol starts to be seen as sin and disease 1870 -sceintists became temperance leaders -focused on addiction as a disease in need of treatment (state asylums) -problems with cocaine, morphine, and opiates increasing with introduction of hypodermic needle -Iatrogenic* explanation of addiction applied to upper and middle classes (medical care causes addiction by prescribing opiates) -moral failure and social contagion explanation for poor and working class -alcohol consumption exploded Early 1900s Moral focus increasing, disease decreasing -regulation of narcotics started -patients who were addicted less trusted -alcohol consumption exploded again -zero tolerance perspective rising in popularity 1920 National Prohibition Law -ban on Salem, consumption, etc. of all alcohol -alcohol is a poison, fault of the person if they drink it and become addicted -most treatment facilities shut down -alcohol used more as prescription in medical settings
Post-Prohibition and Medicalization of Addiction
1930s Great Depression 1933 Prohibition Repealed -prohibition wasn't successful in cutting out drinking (down about 30%) -drug addiction did see a big decrease -Great Depression brought about many changes, including a focus on economics of drinking 1935 AA founded -"compulsive" drinkers who "cannot drink normally" -AA membership on the rise by 1940s Late 1930s, early 1940s Scientific inquiry into alcohol use increasing -opening centers to research substance use -psychoanlystic approaches - character problems ("in denial") 1960s Civil Rights movement and counterculture -increase in other substances (cannabis, hallucinogens) -started considering socioeconomic factors in addictive behavior -confrontational approaches to therapy on the rise
A good theory...
A good theory thus is sturdy and fluid, solid and malleable. It remains relevant by harnessing its dialectical functions of explanation and proposition. In a sense, a good theory is perpetually reinventing itself. A theory is always a map that is in the process of being filled in with greater detail. We do not so much ask whether it is true, but whether it is helpful" (p. 9).
Disease Models - An overview (cont.) AA and Medical communities emphasize different aspects of "disease"...
AA: Spiritual emphasis (higher power, etc. central to recovery) -Addiction is LIKE a disease Medical: focused on brain and neurobiological aspects, genetic susceptibility -Addiction IS a disease
Where we are today
Addiction is *complex* -no single theory accounts for all of the evidence thus far -we have learned a lot; we have a lot more to learn Theories do not always (or even often) translate to real-world practice
Current Views: Addiction is a multi-determined disorder
Addiction is *complicated and complex*, an interplay of -bioloical factors (ex: genes) -psychological factors (ex: beliefs about substance effects) -Contextual factors *poverty, inadequate education, lack of employment opportunities, racism, oppression, little to no access to services Why do "simpler" moral and disease models persist? -complex problems are difficult to solve -"simple" theories and policies (ex: addiction as crime) give the illusion that addiction can be contained -a lot of resources have been poured into law enforcement and residential treatment *sunken coast fallacy
Addiction as Maladaptive Behavior
Addiction is a learned behavior/habit -"Maladapative" suggests that behavior become "unhealthy" or even "harmful" for the person *not* "bad behavior"...just harmful! "The repeated *pursuit of highly attractive goals* and the *brain changes* that condense this cycle of thought and behavior into a *well-learned habit*" -use the substance (behavior) changes occur in the brain (learning) Heavily influenced by societal and environmental factors Mostly not a free-choice, but some aspects of addiction are the result of "poor self-regulation in a challenging environment" (p.28)
Addiction as Immoral Conduct
Advantages: -Parsimonious (straightforward, clear) -Absolute-we don't need to try and figure out the cause or root of addiction Disadvantages: -evidence suggests addiction is complex -it doesn't seem that all aspects of addiction are "freely chosen" (ex: compulsive behavior, environmental contingencies) -punishment is ineffective in reducing addiction in the population
Advantages/Disadvantges of Addiction as a Disease
Advantages: -people helped rather than punished (viewed as victims) -society more willing/likely to give resources to help -this model has helped many people with recovery Disadvantages: -loss of control theory has been scientifically challenged -no specific and single biological cause for addiction has been identified
individualized or customized care
As professionals, we should possess the flexibility to work with different communities and clients, and *tailor our approaches to their needs.* This is the meaning of individualized or customized care.
Chapter 1
Conceptualization Addictive Behavior and the Need for Informed Practice
Denial
Denial is best characterized as an inability to perceive an unacceptable reality; the unacceptable reality is being an "alcoholic" or an "addict." Denial is not lying. *It is actually a perceptual incapacity*
Disadvantages/Advantages of Addiction as Immoral Conduct
Disadvantages: -Evidence suggests addiction is complex -It doesn't seem that all aspects of addiction are "freely chosen" (e.g., compulsive behavior, environmental contingencies) -Punishment is ineffective in reducing addiction in the population Advantages: -Parsimonious (straightforward, clear) -Absolute - we don't need to try and figure out the cause or root of addiction
Disadvantages/Advantages of Addiction as a Disease
Disadvantages: -Loss of control theory has been scientifically challenged -There is no strict, specific, single biological cause Advantages: -People helped rather than punished (viewed as victims) -Society more willing/likely to give resources to help -This model has helped many people with recovery
Epigenetics
Epigenetics: the study of changes in organisms caused by environmental alterations of gene expression rather than by changes in the genetic sequence itself -the dynamic environment in which a human is located can modify the expression of genetic information without changing their fixed DNA coding sequence. *both genetic and environmental factors are important in addiction etiology, and their respective contributions cannot be easily teased apart.*
The triad of causation in public health
Gradually, public health officials came to recognize that more than one factor contributes to the occurrence of disease. ...For instance, it is now known that many persons exposed to tubercle bacillus do not develop tuberculosis and that poverty, overcrowding, malnutrition, and alcoholism are important causal factors in its occurrence *The Triad:* host, agent, environment ex: Agent: alcohol Host: genetics, age, attitudes, expectancies, habits Environment: alcohol availability, family influences, norms
Health Disparities and Poverty
Health disparities: refer to "differences in health outcomes that are closely linked with social, economic, and environmental disadvantage—are often driven by the social conditions in which individuals live, learn, work and play" Root cause of health disparities: Poverty Health Disparities... -increase health risks of racial and ethnic minority groups and the poor -limits the extent to which the health of the wider population can be improved so that unnecessary costs are reduced for society as a whole
DSM-5 Substance Use Disorders
How do we define addiction from a scientific perspective currently
model
In the behavioral sciences, the term model is often used in place of theory. According to West and Brown (2013), *a model describes or represents something, such as an object, a set of events, or a narrow aspect of some behavior.* Unlike a theory, however, a model is not well developed and does not necessarily explain anything
iatrogenic addiction
It was generally believed that physicians were the primary cause of their patients' drug addiction in their efforts to treat such maladies as cholera and dysentery, as well as obstetrical and gynecological problems. *This form of physician-assisted addiction* is known as iatrogenic addiction.
Loss of control
Loss of control is a longstanding and central premise of the traditional disease model of alcoholism. Indeed, Step 1 of AA's "12 steps" is an admission that alcoholics are *"powerless over alcohol"*
Model vs. Theory
Model: -*describes* or represents object/events/aspect of behavior -not usually well developed; *doesn't explain* phenomena -may be ambiguous; or isolated for other models of some phenomena Theory -describes what has been observed and *speculates about meaning* -offers new ways to *explain* observations, *make predictions*, provide a means for future *experimentation*
intemperance
Problematic alcohol use is an "immoral condition"
Chapter 3
Public Health and Prevention Approaches
Everything you think you know about addiction is wrong - TED TALK
Rat park: rats don't like the drugged water Empty box: rats like the drugged water, kill themselves -> what if it is about human bonding ...not being able to bear to be present in your life Portugal: -> decriminalized all drugs, spent the $ on reconnecting addicts with society *social recovery is needed (floor space has increased, number of close friends has decreased) -> opposite of addiction is not sobriety, it is connection W
SNPs
Single-nucleotide polymorphisms: are the *most common form of genetic variation in human beings* -human genome is made up of approximately 10 million SNPs
Logical Inconstency
Some time ago, Fingarette (1988) pointed out that the classic loss-of-control concept is illogical. This concept maintains that after a minimal amount of alcohol enters the body, *all ability to control drinking disappears*
Stigma and Language about Addiction - Video
Substance use disorder is one of the most stigmatized conditions where not only the *patient* is stigmatizes, but also the *disease* is stigmatized and the treatment is *stigmatized* -only 1/10 individuals with SUD access treatment *People should not be defined by their disease 2017: The Associated Press Style Book reccomends AGAINST words like "alcoholic, addict, user, abuser"...instead we should use phrases like "he was addicted" "she used drugs" "people with heroin addiction" Study: "substance abuser" -law enforcement problem "patient with SUD" -mental healthcare problem ...."even among highly trained mental health professionals, exposure to these two commonly used terms evokes systemically different judgements" Replacements: Treatment Failure->Treatment Attempt Medication Assisted Treatment-> Medications for Addiction Treatment
History Brief: The Temperance Movement - Video
Temperance Movement: opposition to alcohol -confined orgins of Benjamin Rush (opposed alcohol sales) 1826: American Temperance Society was formed 1835: 1.5 million members nationwide 1860s: disappeared due to the civil war efforts Post-war: temperance movement is revived 1881: Kansas outlaws sale of alcohol Wet/Dry Division (Wets supported alcohol sales, Drys opposed it) -Carrie Nation -Domestic violence arguments against alcohol -Mississipi ratifies 18th amendment -Jan. 16, 1920 the entire country becomes dry!
Addiction as a progressive disease
That is, if *alcoholics or addicts continue to engage in substance abuse*, their condition will deteriorate further and further. Marital, family, work, and medical problems only worsen over time; they do not get better with continued use. Life becomes increasingly unmanageable. -In Phase 1, learning the mood swing, the drinker is initiated into the use of alcohol -In Phase 2, seeking the mood swing, the drinker purposely drinks to obtain euphoria. -In Phase 3, harmful dependence, an "invisible line" is crossed
Chapter 2
The Disease Models
Chapter 2 Lecture
The Disease Models
What is Public Health?
The World Health Organization (1998) provides two definitions of public health. one definition: simply states that public health is "the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society" (p. 3) second definition: see book
Addiction as a Chronic Disease
The disease models maintain that addiction is a chronic disorder, meaning that it never disappears *(e.g., "Once an alcoholic, always an alcoholic").* The disease can be readily treated with sustained abstinence and growth within AA or NA, but it is never "cured."
theory
The popular understanding of the term theory is that it is *a belief or set of beliefs distinguished from and in opposition to practice, science, and certainty or fact.*
Addiction as Disease
The second broad perspective on addiction contends that excessive consumption of alcohol or drugs is the result of an underlying disease process
Addiction as Maladaptive Behavior
The third broad perspective on addiction is that it is a form of maladaptive behavior. This means that addictive behavior is shaped by the same laws that shape all human behavior. Essentially, *addiction is learned*
Addiction as a Polygenetic disorder
Unlike disorders such as sickle cell anemia and cystic fibrosis,(where mutations = disorder)... for most common diseases mutations elevate risk, or one's liability, for developing disease; that is, the presence of a mutation may increase the likelihood of disease occurrence but *not determine its outcome* with certainty (Krammer et al., 2017). Addiction is an example of one of these complex health disorders that are produced by an interaction of multiple genetic and environmental factors.
neurotransmitters
Vesicles located at presynaptic axon terminals that release brain chemicals
Goals of the text
Written for a wide-range audience who are not addiction specialists Focuses on a number of leading theories, with the intention of: -exposing people to theories -providing evidence for and against theories -providing information so readers can make informed choices about treatment *flexible, customized approaches
Addictionary
a dictionary for all addiction/recovery terms
dypsomania
a heritable medical condition similar to insanity that primarily affected the middle and upper classes.
Defining "theory"
a logical explanation about *why* things happen the way they do
reuptake
a neurotransmitter's reabsorption by the sending neuron
synapse
at the end of each axon, branches terminate at a microscopic, fluid-filled gap known as the synapse
alcoholism
attributed the medical condition for the *first time to the substance*, alcohol, rather than to the behavior of the drinker.
neurons
cells of the brain
Genetic Origins of Addiction: The Susceptibility Model
compelling evidence for the familial transmission os SUDs -occurs via gene-environment interactions
genotype
each person shares 50% of the genes of each parent in a unique arrangement that is different from that of both parents
A Brief History of Public Health in America
earliest attempts: -control of smallpox, malaria, diphtheria, yellow fever, diarrheas and dysenteries, scarlet fever, cholera, typhoid, and other diseases in the colonies 1800s urban cities: -the only water source was an outside well or standpipe, if the city had a water system at all. Frequently, multiple families would share a single toilet facility. Disease spread rapidly under these living conditions. sanitary movement reform: -germ theory: scientists begin to uncover what bacteria causes diseases such as TB, etc.
dopamine
influences movement, learning, attention, and emotion -elevated levels of dopamine in the nucleus accumbens are associated with
mesolimbic dopamine pathway
one of two major dopamine pathways; may be involved in psychotic reactions and in drug reward
inebriety
referred to an involuntary yet habituated condition, reflecting both medical and moral characteristics.
withdrawal
results when the blood or body tissue concentrations of a substance decline following a period of prolonged heavy use
What is the difference between a scientific theory and a law?
scientific law: predicts the results of certain initial conditions ex: your unborn child's hair color theory: tries to provide the most logical explanation about why things happen as they do -> might try to explain how a brown-haired parents ended up with a red-headed child *Law* predicts WHAT HAPPENS *Theory* predicts WHY Theory's acceptance is often gladiatorial (multiple ones may compete to provide the best explanation)
enzymes
specialized proteins that serve as *catalyst for a specific chemical reaction*
Addiction as immoral conduct
that addiction represents a refusal to abide by some ethical or moral code of conduct.
phenotype
the interaction between genotype and environment generates an enormous number of individual traits and characteristics
tolerance
the need to use increasingly greater amounts of a substance to obtain the desired effect
Three broad perspectives of addiction
three broad perspectives on the nature of addiction that remain "alive and well" today. These perspectives regard addiction as (1) immoral conduct (2) disease (3) maladaptive behavior.
