Chapter Ten: Psychological Disorders

Drug Abuse and Addiction

INTRODUCTION

While alcohol and drug use are considered normal behaviors, abuse and addiction are the result of a complex interaction between physiology, psychology, and one's culture.

WHAT'S AHEAD

• Why can two people drink the same amount of wine and have tow different physical reactions to it?
• Why is alcoholism more common in Ireland than Italy?
• Why don't policies of total abstinence from alcohol always work?
• If you take morphine to control chronic pain, does that mean you'll become addicted to it?

KEY CONCEPTS

Introduction: Defining Substance Abuse
The Biological Model
The Learning Model
Debating Theories of Addiction

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Introduction: Defining Substance Abuse [p.354]

KEY CONCEPTS EXPLAINED

..Definition:

Maladaptive pattern of use that leads to clinically significant impairment or distress.

..Impairment:

• Failure to fulfill obligations (e.g. cannot hold a job).
  
  
• Uses drugs in hazardous situations (e.g. driving a car).
  
  
• Recurrent arrests for use.
  
  
• Persistent conflicts with others as a result of using the substance.

LINKS About Alcohol and Substance Abuse

• weblink: National Instituted on Drug Abuse and Alcohol Addiction.
• weblink: National Institute on Drug Abuse.
• weblink: National Clearinghouse for Alcohol and Drug Information
• weblink: Alcoholism defined

The Biological Model [p.354]


INTRODUCTION

The biological model holds that addiction is primarily due to a person's biochemistry, metabolism, and genetic predisposition.

KEY CONCEPTS EXPLAINED

• Just as some individuals and ethnic groups cannot tolerate lactose in milk, some individuals and ethnic groups have a low tolerance for alcohol.
  
  
  • Women have a lower tolerance.
    
    
  • Some Asians have an adverse reaction to even small amounts.
    
    
• Genetic Vulnerability
  
  
  • Type II Alcoholism
    
    
    • Begins in adolescence and is linked to impulsivity, antisocial behavior, and violence.
      
      
    • Lower activity of the enzyme MAOB which may reflect an underlying physiological deficiency that leads to alcoholism.
      
      
• Gene Studies
  
  
  • Mixed results.
    
    
  • No single gene identified.
    
    
  • May be multiple genes which influence response to alcohol, temperament, and metabolism.
    
    
• Counter position - Alcohol consumption may cause the physiological changes rather than be the result of those changes.

LINKS About Biological Causes of Substance Abuse

• weblink: Neurobiology of addiction.
• weblink: Brain activity and cocaine, heroin, and marijuana.
• weblink: Heredity and environment in alcoholism.
• weblink: Why do Asians drink less?
• weblink: Genetic links to alcoholism.

The Learning Model [p.355]

INTRODUCTION

In the learning model, addiction is a central activity in the person's life that depends on learning and culture.

KEY CONCEPTS EXPLAINED

1. Addiction patterns vary according to cultural practices.
   
   
   • More likely in societies that prohibit kids from drinking but condone adult drunkenness (e.g. Ireland) than in cultures in which kids are allowed to consume some alcohol and adult drunkenness is condemned (e.g. Italy).

   • In countries where the rate of alcoholism is low:
     • Adults demonstrate correct drinking habits to children.
       
       
     • Alcohol is not used as a rite of passage.
       
       
     • Alcohol is not associated with masculinity and power.
       
       
     • Drunkenness is not condoned.
       
       
   • Alcoholism rates change when people move to a culture where cultural rules are different.
     
     
2. Policies of total abstinence tend to increase rates of addiction rather than reduce them.
   
   
   • Denies the opportunity for people to learn to drink moderately.
     
     
3. Not all addicts have withdrawal symptoms when they stop taking a drug.
   
   
4. Addiction does not depend on the drug alone, but also on the reason for using the drug.
   
   
   • People taking drugs for chronic pain do not become addicted.
     
     
   • Coping drinkers (reduce negative feelings) are more likely to have addiction problems than enhancement drinkers (increase positive feelings when tired).

LINKS About Learning Causes of Substance Abuse

• weblink: A brief review of many different models of alcohol abuse.
• weblink: Challenging the disease model of alcoholism. .
• weblink: "How Culture Influences the Way People Drink"
• weblink: Alcohol and advertising.
• weblink: Challenging the disease model of alcoholism. .

Debating Theories of Addiction [p.357]

INTRODUCTION

The debate about which model of addiction is right has serious policy implications. The controversy over controlled drinking highlights the intensity of the debate.

KEY CONCEPTS EXPLAINED

..Controlled Drinking Controversy

• Disease Model: Have to totally abstain from drinking forever.
  
  
• Learning Model: Once the reasons to have to drink are removed, the person can socially drink in moderation.
  
  
  • Supported by some longitudinal studies indicating personal maturation, changing environments, and changing reasons for drinking did occur for drinkers.

..Factors that predict one's ability to control excessive drinking.

• Previous severity and dependence on drinking.
  
  
• Social stability.
  
  
• Stable work history.
  
  
• Beliefs about abstinence.

..Problems with alcohol/drugs occur when there is:

• Genetic or physiological vulnerability.
  
  
• Belief that one has no control over the drug.
  
  
• Customs that encourage people to binge, and moderate use is not encouraged.
  
  
• Seen as a way to cope with problems.
  
  
• Peer group drinks heavily.

In Sum, abuse and addiction reflects an interaction between physiology and psychology, the person and the culture.

LINKS About Controlled Drinking Controversy

• weblink: A chapter on the controlled drinking controversy .
• weblink: "Harm reduction and moderation as an alternative to heavy drinking."
  
  HARM REDUCTION AND MODERATION
  
  AS AN ALTERNATIVE TO HEAVY DRINKING .

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