Module 4: Theory Explaining Drug Use

Psychological Theories

Based either on reinforcement, whether positive or negastive, or personality type •Reinforcement theories suggest individuals continue drug use because they have a past history of being rewarded for doing them •Personality theories suggest individuals have a type of personality that compels them to use/abuse drugs Focus on 3 factors: 1.Positive and/or negative reinforcement 2.Inadequate personality 3. Problem behavior-proneness

Successful Prevention Programs

1) Should be focused on both preventing use and accurately educating (especially young people) to make rational decisions •What works in schools? (Stigler et al. 2011) •INTERVENTIONS THAT: •are theory driven, with a particular focus on the social-influences model, which emphasizes helping students identify and resist social influences (e.g., by peers and media) to use alcohol. •use interactive teaching techniques (e.g., small-group activities and role plays) to engage students. •address social norms around alcohol use, reinforcing that alcohol use is not common or acceptable among youth. •build personal and social skills that help students resist pressure to use alcohol. •use same-aged students (i.e., peer leaders) to facilitate delivery of the program. •are conducted across multiple sessions and multiple years to ensure that an adequate "dose" of prevention is received by students and schools. •provide adequate training and support for program facilitators (i.e., teachers, students). are both culturally and developmentally appropriate for the students they serve 2) Should focus on the person who is using it and the circumstances under which drug use occurs (rather than the drug itself) •No drug is inherently more evil than the other and the overwhelming majority of drug users do not become addicted (Drugs themselves are not the problem) •People become addicted for a variety of reasons ranging from genetic pre-dispositions to psychiatric disorders to economic desperation, etc. 3) It is critically important to determine the reasons underlying each person's addiction before intervening with scare tactics or other hasty solutions •Ex: if a person is using heroin to deal with anxiety or trauma, effective treatment of the psychiatric illness should alleviate the need to use heroin. •Ex: providing destitute addicts with specific skills and viable economic opportunities will go a long way in helping them to overcome their drug addiction. (Ex: Portugal Drug Policy) 4) "one size doesn't fit all" and careful assessment is an important component in helping addicts or preventing use in specific populations (i.e. students/young people; different cultural groups; those with risk factors; former users, current users, or at-risk users, etc.) EX. Ineffective Montana Meth Project EX. D.A.R.E

Tertiary Prevention

Aimed at people at (a) very high risk of substance use issues (e.g., those who display antisocial or other risky behaviors such as associating with peers who use substances) or (b) at those that have been through substance abuse treatment or who stopped using a drug on their own Also called "indicated programs" Goal is relapse prevention if drug use is present Goal is prevention of drug use for those at very high risk for starting

Secondary Prevention

Aimed at people who have experimented with drugs but who typically aren't suffering serious consequences from drug use Also called "selective programs" Many college students fall into this category; also includes other groups considered to have risk factors (e.g., children of substance users; those who display problems at school) Goals Prevention of use of other, more dangerous substances; Prevention of more dangerous forms of use Example = college programs encouraging responsible use of alcohol

Primary Prevention

Aimed at young people who have not yet tried the substances in question May encourage abstinence and help teach people how to view the potential influence of drugs on their lives, emotions, and social relationships Must avoid giving information in ways that arouse children's curiosity and encourages them to try the substances in question Sometimes called "universal programs"

Social Influence Model

Applied to smoking cessation It is possible to design effective smoking prevention programs Presenting information about the delayed consequences of smoking (e.g., lung cancer) is relatively ineffective Presenting information on immediate effects (e.g., shortness of breath; bad breath; bad skin; ugly teeth, etc.) is more effective Five key elements 1.Training in refusal skills through films, discussion, and practice 2.Public commitment such as making a public pledge 3.Countering advertising by inoculating children against it 4.Normative education to teach students that they may overestimate the number of their peers who smoke (with real statistics) 5.Use of teen leaders to talk to younger students about cigarettes EX. DARE

Differential Association Theory

Argues that crime is a behavior that is learned from others (i.e. family members; delinquent peers) who believe criminal behavior is acceptable Lays out nine propositions that outline the arguments of the theory to explain juvenile delinquency as a learned behavior: 1. Criminal behavior is learned. (drug use is a learned behavior) 2. Criminal behavior is learned through the process of communication/interaction 3. Criminal behavior is learned from family, friends, and close companions 4. Learning criminal behavior involves learning techniques, motivations, drives, rationales, and attitudes 5. The specific direction of motives and attitudes is based on interpretations of the legal code as favorable or unfavorable ... and criminal behavior as acceptable/unacceptable 6. A person becomes a criminal when there is an excess of interpretations favorable to violations of the law as opposed to unfavorable interpretations 7. Differential associations vary in frequency, duration, priority and intensity, which may intensify the learning process ("modalities of association"): A. Priority - the earlier in one's life one is exposed to favorable definitions (attitudes and values) of crime, the greater the likelihood one will commit a crime B. Intensity - the closer more intimate the friends, relatives, and acquaintances that endorse criminal behavior (express favorable definitions of crime), the more likely one will commit a crime C. Frequency - the more frequently one associates with those who express favorable definitions of crime, the more likely one will commit a crime D. Duration - the longer one associates with those who express favorable definitions of crime, the more likely one will commit crime 8. The process of learning criminal behavior involves all the mechanisms involved in any other learning 9. Although criminal behavior is one expression of general needs and attitudes, criminal behavior and motives are not explained or excused solely by the same needs and attitudes People may have the need to reduce stress, however there are many possible behavioral expressions of this drive besides drug use (exercise, therapy, etc.)

Ronald Aker's Social Learning Theory

Builds on Differential Association Theory Four main elements in Aker's theory: 1. Imitation Individuals learn how to make the decision to engage in crime (drug use) by modeling other criminals' behavior (drug use) - most likely to be involved in the initiation of a behavior Most likely to occur when they are around others who get rewarded in some way for their drug use (examples???) Similarly, imitation of drug use is less likely to occur if the individual sees someone get punished for it 2. Differential Reinforcement Behavior is reinforced by being either rewarded or punished while interacting with others Refers to the balance of perceived, experienced, or anticipated reward and punishment for behavior Positive and negative reinforcement; positive and negative punishment 3. Definitions justifications from the individual to rationalize certain inappropriate behaviors (such as drug use), which allow them to square their self-images with the obvious harm of their actions The process through which an individual rationalizes, evaluates, and assigns right and wrong. So the person may find self-esteem or a sense of positive identity in being a drug user 4. Differential Association argues that crime is a behavior that is learned from others who feel that criminal behavior (such as drug use) is acceptable This element of Aker's theory extends Sutherlands idea of differential association by examining the type of exposure to others Shows that certain groups are more likely to have an impact on others (such as parents, teachers, coaches, pastors, adult mentors, and peers Also includes "modalities of association" from Differential Association Theory In addition, the media can be a source of learning

Types of drug prevention programs:

Drug Prevention Programs in Schools (most common) •peer programs •parent and family programs •community programs •workplace programs •media campaigns

Social Learning Theories

Main assumption: people engage in delinquency (i.e. drug use) because they have been exposed to people who find criminal behavior acceptable and have been taught how to be delinquent and how to justify their behavior In sum: The social learning theory postulates that an adolescent's involvement in substance abuse has three sequential effects: it begins with the observation and imitation of substance-specific behaviors it continues with social reinforcement such as encouragement and support for drug use This also occurs along with differential association and the learning of positive definitions of drug use it culminates in a juvenile's expectation of positive social and psychological consequences from continued drug use

Conflict Theory

Main assumption: power dimensions in the social structure and institutions that make up society affect: how we label and treat delinquent/criminal offenders, including drug users and addicts who we are more likely to label what behavior we criminalize Rather than explaining criminal behavior in terms of socialization into attitudes, values, beliefs, and behaviors that deviate from some underlying cultural consensus, social conflict theories argue that the legal system is itself only reflective of the interests of those with power In turn, those without economic, political, and/or social power are more likely to be labeled and treated as criminals (that is... the most vulnerable drug addicts are more likely to be arrested, punished rather than treated) AND, their behaviors are more likely to be criminalized In The Social Reality of Crime, Richard Quinney builds upon the argument that the elite use the legal system to control those without power. They do so by defining certain acts as criminal and using the criminal justice system to keep people from gaining access to their resources. Because they control the system, as well as the media, the elite can control not only who becomes a criminal, and what their punishment and long-term future consist of, but also the public's perceptions of crime (ex: The New Jim Crow: Mass Incarceration in an Age of Colorblindness (and the War on Drugs) - explains how War on Drugs criminalized drug addiction making it a crime rather than a public health issue and disproportionately affects poor people and people of color)

Anomie/Strain Theory

Robert Agnew's General Strain Theory (GST): individuals who experience strains or stressors often experience negative emotions and sometimes cope with crime (i.e. drug use): •to end or escape strains •to makes self feel better •to seek revenge against the source of their strains or related targets •Strain refers to events or conditions that are disliked by individuals and can fall into three broad categories: •1. People may lose something they value - lose something good like money, friends, romantic partners, etc. •2. People may be treated in a negative manner by others - receive something bad like verbal or physical abuse •3. People may be unable to achieve their goals - fail to get something they want - to obtain money or respect they want or self-worth •Why does strain lead to an increase in the likelihood of crime/delinquency? •Strain leads to negative emotional states (anger, frustration, jealousy, depression, and/or fear) •Strain reduces effectiveness of social control (less stake in conformity) •Strain may foster the social learning of crime •Chronic strain may foster the traits of negative emotionality and low constraint/self-control The experience of one or more of these types of strain does not necessarily lead to crime/deviance, such as drug use Strain is most likely to lead to crime/deviance when the strain is high in magnitude and perceived as unjust associated with low social control (i.e. parental rejection) create pressure or incentive for criminal coping like drug use (i.e. frustration with society, hopelessness)

Public Health Model

Stresses interactions among... •An agent—alcohol, tobacco, or some other drug. (pharmacological and biological) •A host—the individual user. (biological and psychological) •The environment—the social, cultural, and physical context in which use occurs (sociological) •To make a lasting difference, prevention efforts need to address all three parts of this model ... and understand the risk and protective factors at both the individual and community level primary, secondary, and tertiary prevention

Theories of Drug Use or Abuse

Theories that attempt to explain WHY people use or abuse drugs Two conditions must be met: 1. A predisposition and/or motive and/or susceptibility to use drugs 2. Availability and access to drugs (affected by culture, social policy, religion, economic status, and drug trafficking, and it changes across time and space) •Each theory does not necessarily explain all cases of drug use and abuse ... and explain deviant drug use and/or abuse (rather than instrumental use) •Each theory has limited scope ... so different theories are not necessarily contradictory, but complementary ==>Biological Theories ==>Psychological Theories ==>Sociological Theories

Biological Theories

These theories are based on physical causes, such a genes, hormones, neurological factors, etc. Assume that specific physical mechanisms in individuals impel or influence them either to experiment w/ drugs or to abuse them once they are exposed to them 2 such theories: 1. Genetic theories •Genetic theories (of drug use) = rely on chromosomal differences in the population which influence the predisposition to take or abuse psychoactive substances •Gene or combination of genes influence biological mechanisms relevant to substance abuse: •Being able to achieve a certain level of intoxication •Lowering/not lowering anxiety levels when under influence •Capacity to metabolize chemical substances A lot of research is focused on alcoholics Children of alcoholics (COA) Four times more likely than other children to become alcoholics. Seem less affected by alcohol (lower sensitivity, debilitation, hormone response) Genes (in combination with other factors) play a role in determining risk level for chronic, compulsive, destructive drinking 2. Metabolic imbalance •This theory focuses specifically on narcotic addiction •Proposes that opiate addiction is caused by an incomplete biochemical makeup, which narcotic drugs complete •Once persons with a metabolic imbalance begin using narcotics, a biochemical process kicks in to make their bodies crave opiate drugs and render them prone to becoming addicts •No biological mechanism corresponding to metabolic imbalance has ever been found (but addicts behave as if they suffer from an imbalance) •Ex: Methadone maintenance (based on this theory) - has helped a certain proportion of addicts •The ultimate goal would be to wean one off of opioids using methadone; however, some people find themselves reliant on methadone indefinitely in order to function and stay productive. •Methadone is an opioid agonist (with longer half-life) prescribed for opioid dependence •Works as substitute due to cross tolerance effect (blocks effects of other opioids); longer lasting, less intense (less euphoria/sedation) •Also a "harm-reduction" strategy (i.e. shown to reduce: overdose deaths, criminal behavior, the use of illicit opiates, risky sexual practices, and the transmission of HIV) •Ex: Suboxone (burprenorphine) •Buprenorphine is a partial opioix agonist - it activates the opioid receptors in the brain but less than a full opioid agonist like methadone •Buprenorphine also acts as an opioid antagonist - it blocks other opioids, while allowing for some opioid effect of its own to suppress withdrawal symptoms and cravings. fall under the category of "medically-assisted treatment" (MAT) of addiction

Labeling Theory

This theory does not necessarily explain why someone initially uses drugs but can tell us why people may continue to use/abuse drugs AND why harsh punishment for drug use may be counterproductive (compared to treatment and rehabilitation) Main assumption: people are stigmatized by social labels ... these labels become part of their identity. Once a labeled individual internalizes their label, they may seek out others who have been similarly labeled to find acceptance and to avoid stigma A person labeled a delinquent or criminal drug addict will associate with others delinquents/criminals and/or drug addicts... leading to more drug use argues that society creates criminals, delinquents, and deviants (such as drug addicts) based not on the harm caused by their acts but on the way in which society labels such behavior a consequence of being labeled is that it can isolate/alienate an individual and causes that individual to continue engaging in the deviant labeled behavior such as drug use When an addict is labeled a deviant/moral failure/criminal (rather than someone who needs help/treatment), it affects their identity Looking glass self: the self-image an individual forms by imagining what others think of his or her behavior and appearance If someone is labeled or treated like a deviant or a bad person, they may begin to see themselves as a bad person Self-fulfilling prophecy: insofar as an individual internalizes this label and alters their self-concept to that of a stigmatized identity, the individual becomes more likely to continue to act out that label (i.e. engage in more drug use)

demand

To attack the source of a drug problem, _____________ for drugs must be eliminated

Sub cultural Theories

group-based norms, values, beliefs, and behavior that support drug use will increase use of its members ***Learning to accept drug use and to use drugs is even more likely to occur in subcultures that promote or encourage substance use and abuse

Sociological Theories of Drug Use

make use of broader, structural, cultural, or institutional factors and variables to explain drug use and abuse 1. Anomie/Strain Theories 2. Social Control Theories 3. Social Learning Theories 4. Labeling Theory 5. Conflict Theory

Reinforcement Theories

•1. Reinforcement Theories (of drug use) •Reinforcement theories (of drug use) = based on the idea that drug use is caused by the reinforcing effects of psychoactive drugs •Positive reinforcement = motivation to continue using drug because of positive sensations (physical or psychological) •Negative reinforcement = motivation to continue using drug to avoid withdrawal symptoms (or other sources of physical or psychic pain) POSITIVE = ADDING SOMETHING NEGATIVE = TAKING SOMETHING AWAY REINFORCEMENT = INCREASING A BEHAVIOR PUNISHMENT = DECREASING A BEHAVIOR •Most people who try drugs do not go on to abuse them so it cannot just be the drugs direct effects that are "reinforcing" of drug use (also, not all drugs produce a physical dependence but a psychological one) •What other "positive reinforcements" and "negative reinforcements" may occur with drug use that would account for why some people become psychologically dependent on drugs? •Ex: Negative reinforcement may be occurring if addicts are avoiding withdrawal symptoms, escaping reality/rejection, self-medicating, or avoiding loss of using friends. •In such cases, therapists may use: response prevention, generating alternative activities, environmental interventions within the family and community, and emotion regulation and distress tolerance skills •Mostly done through some sort of cognitive behavioral therapy Cognitive Model: " How you think determines how you feel and how you behave Thought-Emotion-Behavior Once you become aware of your own irrational thoughts, you will learn to change them Distortions: All or nothing thinking- you see things as black and white Mental Filter- you pick out a single negative detail and dwell on itso that your vision of all reality is darkened Overgeneralization- you see a single negative event as a never ending pattern of defeat Disqualifying the positive Jumping to Coclusions

Problem Behavior Proneness Theory

•Argues that drug use is one specific manifestation of a wide range of problematic behaviors •Drug users more unconventional and risk taking than nonusers •The more unconventional the youth, the greater the likelihood he/she will use drugs; the more unconventional, the more serious the drug involvement

Inadequate Personality Theories

•Assume that young people who lack self-esteem, are unable to cope with life, and/or who are failures, turn to drugs to drown out the feelings of failure •Drugs use masks some of life's problems •The more inadequate the personality, the greater the likelihood of becoming highly involved in drug use •Drug use is a kind of crutch •Drug use also viewed as defense mechanism •Self esteem/Self-derogation theory (one type/category of inadequate personality theory): •Drug use/abuse are responses to low self-esteem and self-rejecting attitudes •Low self esteem can come from peer rejection, parental neglect, high expectations for achievement, school failure, physical or social stigma, etc. •Deviant/disapproved activities and memberships act as effective sources of self-enhancement and sense of belonging

DARE

•Began in 1983 - joint project of the LAPD and LA school district. •Somewhat based off the social influence model of smoking cessation. •Education delivered by police officers in uniform originally in fifth- and sixth-grade classrooms •17-week program spread rapidly across the United States in 1980s anti-drug climate By the early 1990s, DARE programs were found in every state •Its effectiveness in preventing drug use was not evaluated extensively until 1994. •In 1994: two main large-scale studies of the effects of DARE •One study: the program had some effects on reported self-esteem, there was no evidence for long-term reductions in self-reported use of drugs. •The other study: the effects on drug use were marginal at best. There was a very small but statistically significant reduction of tobacco use and no reliable effect on alcohol or marijuana use. •A more recent review of 20 studies on DARE published in peer-reviewed journals found an average effect size that was small and not statistically significant. •While based off of social influence model, it fell short by: •not emphasizing interaction and role playing techniques between students •employing scare tactics through use of police officers •lasting only a few months •being run almost exclusively by adults, without use of peer leaders •focusing too much on drug abuse of illegal drugs rather than alcohol and tobacco •focusing too much on telling students to "just say no" without teaching them the needed interpersonal skills Today's DARE promotes an education program that has a stamp of approval from the Substance Abuse and Mental Health Services Administration. Makes up for identified deficiencies of old program The replacement program, titled "keepin' it R.E.A.L.," launched in 2011. Its developers say it's "not an anti-drug program," but is more centered on decision-making skills, "things like being honest and safe and responsible." But, unlike DARE, it's been demonstrated in a handful of studies to reduce the risk of drug abuse R = refuse drugs E = explain why you are refusing A = avoid situations where drugs will be taken L = leave situations where drugs are being taken Students who completed "keepin' it REAL" showed less subsequent experimentation with drugs than those in a control group, and used a wider variety of strategies to stay sober. Their antidrug attitudes were also more likely to stick over time.

Prevention through Education

•Goal: Provide people the tools to be in a position to act more rationally with accurate information about drugs potential harm •For example, alcohol abuse prevention educates people about the potential dangers of its use but does NOT attempt to convince everyone to avoid all alcohol use. •However, hopefully, it prevents potential harm related to substance abuse/misuse •Success of the program is measured by how much a person knows accurate information about various drugs not whether he or she is convinced never to use any of these substances.

Social Control Theory

•Main assumption: people are inherently driven to pursue their own self interests and therefore must be compelled to follow society's rules •People are self-interested and deviance is inherently attractive ... so what keeps people from engaging in deviance/crime/delinquency? •We do not engage in deviant acts b/c of the strong bonds with or ties to conventional, mainstream institutions. •To prevent deviance such as drug use, society has to create meaningful connections among individuals that must trump otherwise selfish interests and individuals (through proper socialization and other informal controls) •Social control theorists often argue that deviant behavior (such as drug abuse) can be changed through resocialization: •with a stronger influence of family, school, church, and law-abiding schoolmates can change individuals' delinquent behaviors. •These theories also concentrate on the process by which social bonds are created and strengthened or weakened •Ex: Travis Hirschi's Bonding Theory Focused largely on juveniles: A juvenile is more likely to engage in delinquent acts when he or she's bond to society is weak or broken. Hirschi theorized that individuals who are most tightly bonded to positive social groups, such as family, the school, and successful peers, are less likely to commit delinquent acts. If a youth has a very weak connection to the larger society, then that individual is free to pursue self-interests without concern for society's condemnation. In contrast, if an individual has tight bonds to social groups such as family, school, or peers, he or she is less likely to commit delinquent acts This theory has strong empirical support However, this theory does not explain the factors that create or weaken social bonds Four factors that describe the bonds that individuals form to society: 1. Attachment positive bonds with individuals and legitimate institutions in society refers to an individual's connection to or level of integration with others involves the ability to adopt or internalize societal norms and the development of a conscience (product of proper socialization) also refers to the intimate connections to and relationships with significant others, such as teachers, parents, and friends 2. Commitment dedication to legitimate, conventional goals refers to a willingness to dedicate time, resources, and energy to conventional goals such as education and development of a good reputation. the risk of losing the respect of significant others is one of the most significant factors that contributes to youths' conforming behavior. 3. Involvement spending time doing conventional activities relates primarily to time management (i.e. no extra time to engage in things like drug use) heavy involvement in activities such as studying or helping others means there are fewer opportunities to engage in delinquent acts 4. Belief worldview that crime is unacceptable delinquency results from a belief system that suggests criminal behavior is acceptable. belief that drug use is bad and risky reduces likelihood that one will engage in drug use

Prevention through propaganda

•presenting negative information (often exaggerated for effect) about alcohol and other drugs with the clear goal of prevention of use. •Success measured by how many people subsequently did not experiment with the drugs targeted in the program •Until the early 1970s, few attempts were made to actually evaluate programs in any way EX. Montana Meth Project •in 2005, the state of Montana adopted a graphic advertising campaign •At the end of advertisement, printed on the screen is the message: "Meth, not even once" •A recent critical review of the impact of the Montana Meth Project on meth use indicated that the advertisement campaign had no effect when preexisting downward trends in methamphetamine use were taken into account. One potential reason for the lack of success is that the individuals who are most likely to use methamphetamine find the advertisements laughable because they exaggerate methamphetamine-related harmful effects. •Some educators and health care professionals have expressed concern that the types of embellishment used by the Montana Meth Project decrease their credibility and relevance •This leads many young people to reject other drug-related information from "official" sources, even when the information is accurate. EX. Face2 Face Program •Shown computer animated prediction of physical effects of meth use (no empirical evidence to back up "prediction") •Also told: ""The addiction to methamphetamine is over 90 percent after the first-time use. (not true - more like 15%) •These exaggerations led to passing of more restrictive (ex: pseudoephedrine) and punitive laws •Initially, the supply of methamphetamine was substantially disrupted, but this effect was only temporary. •Within 18 months, the methamphetamine market had returned to pre-intervention levels. This suggests that legislation aimed at restricting precursors such as pseudoephedrine may have only short-term effects on illicit drug markets, while it permanently reduces the ability of the whole population to obtain effective cold medications