PSYC 415: (13 Oct.) Vocabulary Flashcards: Psychological Theories of Addiction (Lecture Notes)

Self medication

MOOD DISORDERS

- Almost one quarter of individuals with

mood disorders report using alcohol or

drugs to self-medicate symptoms

- Highest prevalence was seen in Bipolar I

disorder (41%)

- Men were more than twice as likely as

women to report engaging in self-

medication for their mood disorder

- Why this gender difference

• Study examining the prevalence and correlates of self-medication of anxiety disorders—not necessarily SUD, but using non-prescribed drugs or alcohol to “treat” symptoms”

• Frequencies of self-medication

– 7.9% (social phobia, speaking subtype)

– 35.6% (generalized anxiety disorder).

– Among respondents with an anxiety disorder, self-medication was significantly associated with an increased likelihood of comorbid mood disorders, substance use disorders, distress, suicidal ideation, and suicide attempts.

Personality Disorders, Personality Traits, and Alcohol and Drug use

Substance misuse is so common in certain personality disorders it is included as a diagnostic criteria: antisocial personality disorder and borderline personality disorder

• Antisocial personality disorder:

- Hypersensitivity to reward which makes them

- seek pleasurable reinforcement more

- care about possible negative consequences

less than others

• Borderline personality disorder:

- Extremely unstable and painful emotions are common; drug and alcohol use are seen as a form of self-medication

• Certain personality traits (even if

  they don’t reach a pathological level)

  are consistently associated with

  higher likelihood of drug use

  - Impulsivity / lack of constraint

• More likely to jump at immediate reward without thinking of consequences

• Have a harder time stopping or stemming behavior once it has started

  - High sensation-seeking

  Preference for novel experiences

  - Neuroticism (emotional moodiness, irritability)

  - Introversion with low positive emotional tone

  (Extroverts who are generally positive may have more available sources of reinforcement / pleasure)

PTSD and Substance Use Disorders in Veterans

• More than 2 of 10 Veterans with PTSD also have SUD.

• War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to bad memories of combat trauma.

• Almost 1 out of every 3 Veterans seeking

treatment for SUD also has PTSD.

PTSD SUD 20%

• The number of Veterans who smoke

(nicotine) is almost double for those

with PTSD (about 6 of 10) versus those

without a PTSD diagnosis (3 of 10).

• In the wars in Iraq and Afghanistan,

about 1 in 10 returning soldiers seen in

VA system have a problem with alcohol

or other drugs.

PTSD Synptoms

In addition to having experienced a severe traumatic event leading to an experience of fear, helplessness or horror, there are four types of symptoms experienced following the trauma

• AVOIDANCE: Avoid people, places, and things associated with the trauma; avoid thinking about the trauma; numbness

• INTRUSIVE MEMORIES/REEXPERIENCING: Nightmares, Flashbacks, Intrusive Memories

• AROUSAL: Easily startled, Irritable, Trouble sleeping, Negative Changes in Thinking and Mood, Fear, Guilt, Shame, Blame, Emotional Numbness, Detachment from Others

4 Issues specific to PTSD that increase SUD risk

1. Drug and alcohol use allows continuation of the cycle of "avoidance" found in PTSD. Avoiding bad memories and dreams or people and places can actually make PTSD last longer. A person cannot make as much progress in treatment if they avoid memories and problems.

2. PTSD may create sleep problems (trouble falling asleep or waking up during the night). PTSD sufferers "medicate" themselves with alcohol or drugs because they think it helps sleep, but drugs and alcohol change the quality of sleep and make you feel less refreshed.

3. PTSD makes sufferers feel "numb," like being cut off from others, angry and irritable, or depressed. PTSD also makes them feel "on guard." Drugs and alcohol are taken to reduce these experiences, but all of these feelings can get worse when drugs and alcohol are used.

4. PTSD sufferers may drink or use drugs because it distracts them from

   problems for a short time, but drugs and alcohol make it harder to concentrate, be productive, and enjoy all parts of life.

Alternative Pathways to Substance Misuse

• Specific Theories relating mental health problems and substance use

• Psychodynamic theory (Freud

and others)

• Tension or drive reduction

• Focus on anxiety and defenses

• Khazantian’s self-medication model

• Stress and Coping Models

Stress and Coping Models

Drug use in general and problematic drug use particularly will be more
likely in individuals who have more stressors and fewer or less effective
coping resources.

• Stressors = Internal or external demands that are “appraised by the
  person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus & Folkman, 1984, p. 19).

• Coping = Cognitive and behavioral responses to stressors enacted to
  manage them.

Different types of Stressors

Acute (one-time event) vs. Chronic (ongoing stressful circumstances)
• Cataclysmic events (strong stressors that occur suddenly and
typically affect many people at once).

• For example, natural disasters

• Personal stressors: major life events that have immediate negative consequences that generally fade with time.

• Death of a family member; loss of a relationship; car accident

• Background stressors (“daily hassles”): everyday annoyances, such as being stuck in traffic, that cause minor irritations and may have long-term ill effects if they continue or are compounded by other stressful events.

• The flip side is uplifts, the minor positive events that make us feel
  good—even if only temporarily.

There is a relationship between stressful events and substance use, but this is mediated by coping. Persons with a history of a larger number of stresses (cumulative risk) are-

-are more likely to initiate drug use, but this is not the only important variable

• Many people face extreme stresses daily and do not use

• Is dependent on their coping styles and resources
  – Will look start by looking at some specific forms of stressors and then will turn our attention to coping styles and strategies that increase and decrease risk of drug use.

Adverse Childhood experiences

ACES are chronic stressors experienced in childhood which impact a wide range of health outcomes, including substance use and addiction

• Strong relationship between the experience of a number of specific adverse experiences in childhood (called ACES) and early initiation of substance use, along with later problem use.

• Risk is cumulative—that is, the more different types of adverse experiences one experiences, the higher the risk

• Original list focusses largely on experiences in the home

• Additional ACES were added relating to broader environmental stressors, including to community violence exposure, experiences of racism

Adverse Childhood experiences (ACES) and relationship to drug and alcohol
problems

The relationship of adverse childhood experiences to adult health, well being, social function and health care”, a book chapter by Drs. Vincent Felitti and Robert Anda, in “The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease.”

• Exposure to community violence, systemic racism also
  increase risk

COPE measurement

Commonly used measure to assess strategies that are
used to deal with stressors.

• Problem-focused Coping: is aimed at problem solving or
  doing something to alter the source of the stress.

• Emotion-focused Coping: is aimed at reducing or managing the emotional distress that is associated with (or cued by) the situation.

  • Can be expressive or avoidant

Addressing Questions of Risk and Resilience

Many people face extreme stresses – daily or acute stressful events – and
do not use; they do not turn to alcohol or other drugs
• WHY: It is just as important to understand why people don’t use as why people do if we want to create effective prevention and intervention strategies and programs

• On the other hand ... For people who do experience stressors and who end up using alcohol or other drugs, it is important to understand the intervening factors between the stressor and the alcohol or drug use; Understanding the intervening factors helps us to know when and where to target our interventions