PSY389 LECTURE 1: Historical Context and Theories of AOD Use

Why is understanding historical views on substance use important?

1. Attitudes/perceptions/views change with time

2. Attitudes to drugs and alcohol are different in different places/countries

3. Beliefs may influence behaviours of drug users

4. Beliefs influence drug policies

5. Beliefs influence treatments of substance abuse/dependence

History of alcohol beliefs

• Part of European culture

• Beer was a food source

• Drunkenness was a sin

• Compassion to drunkenness was shown but punishment also

• Punishments were consistent with the normal processes of social pressure, control & restraint on alcohol use of that time (from religious beliefs)

• Therefore, peoples attitudes towards alcohol use was considered moral

The moral model

Problem lies in the moral weakness of the person (lack of will power to restrain from substance use and for moderation or abstinence))

The moral model interventions

Strengthen people’s will power by encouragement, teaching, exhortation, punishment, social pressure.

Post moral model

• Advanced method of distilling wine into stronger drinks (e.g., vodka, brandy , whiskey)

• Problems became worse during industrial revolution with economic & social changes where people could afford to drink.

• Drinking increased and so did social issues

• Accidents occurred due to drinking while operating machinery

• Government subsidised farmers for growing grains (surplus of grains was turned into gin).

• Problems escalated → a change in people attitude

• In 1826 a treaty for alcohol called “Six Sermons on Intemperance” & formation of “American Temperance Society” in the US & UK.

• Temperance Society: drink in moderation or not at all

Early pharmacological model

• Problem lies in the substance itself i.e. its pharmacology, not the person

• Alcohol was known as the ‘demon’ drink

Early pharmacological model Interventions

• Temperance, Teetotal, prohibition, abstinence from the harmful pharmacological effects of alcohol.

• Temperance movement flourished in America & spread to Britain

Temperance movement

• Split occurred between those who believe in moderation (Temperance) and those in total abstinence ('Teetotaller“)

• Triggered debates: moral persuasion and legal coercion

• Debates ended with introduction of Prohibition (banning of alcohol sales) in US after the First World War

Prohibition

Did not reduce alcohol related problems as:

1. Drinking continued illegally

2. Created crime and corruption associated with underground manufacture and sale of alcohol

3. Public lost respect for law

Public opinion swung against in 1930s, which was repealed in 1933

Alcoholic Anonymous

• helping people to become abstinent

• AA grew rapidly as many saw AA as hopeful

• Narcotics Anonymous (NA) and Cocaine Anonymous (CA) developed

• AA claimed success: 1.50% people achieved sobriety - 2. 25% achieve sobriety, after several relapses - 3. 25% showed improvements

• Difficult to determine efficacy of AA treatment due to its anonymity

• Abstinence rates of 25-50% (similar to hospital treatment programs)

Early disease model

• Problem lies in the user, who is somehow infected by the agent (alcohol) and cannot resist it, leading to a disease of the will

• Disease of mind led to disorder functions of health

• Leading to semi-scientific intervention treatment (development of treatment facilities)

• Main goal of treatment involved total abstinence from all forms of liquor.

This model generated hall marks for modern view of 'alcoholism‘, including:

1. compulsive loss of control over drinking

2. it is a disease

3. abstinence was the only cure

Late disease model

• Jellinek (1937) proposed disease model involving loss of control over drinking

• Problem lies in a few users who are susceptible to the harmful substance

• Majority drink without harmful consequences but only a few will become infected and require treatment

• Calling for non-judgmental response and compassion treatment

• Organisations were formed: Yale Center for Alcohol Studies (1937), National Council on Alcoholism (1962), and N.I.A.A.A (1970).

• Gained support of American Medical Association and World Health Organisation (WHO)

Main challenge to Jellinek’s Disease model

‘Loss of Control’:

1. Once drinking starts, one cannot stop

2. The problem becomes worse and worse

3. One loses complete control over one’s drinking

• But ‘loss of control’ is not as hopeless as it is thought!

• Natural recovery of Vietnam veterans from heroin addiction when retuning to the US (Tutorial 1 reading Robins (1993)

Reflection on historical models

• All are true in part but each represents only part of the whole picture of dependency

• Moral – individual’s ‘lack of will’ which can be changed with rewards to ‘try harder’

• Pharmacological – drugs certainly provide reward for repeating behavior

• Disease – dependence can be “caught” by modeling on other people (environmental factors)

Weil(1973) – one theory of why people take drugs

The desire to alter consciousness is innate, normal drive such as hunger or sex desire

This theory proposed that:

1. Innocent children experienced ‘altered consciousness’ through whirling, choking each other, sniffing cleaning fluids or gasoline;

2. When they become older they ‘experiment’ drinking alcohol or smoking tobacco for the first time,

3. In adulthood, their drug use/abuse becomes fullblown.

Theories of alcohol and Other Drug Use:

• Psychologically based theories (Intrapersonal, Personality/Temperament)

• Biologically based theories (Biologically based Personality)

• Socially based theories (Social Learning and Social Influences, Expectancies)

Intrapersonal theories

Tension reduction theory:

• drug use reduces tension and helps relaxation

The stress response dampening theory: physiological responses to drug use reduce stress (applies to individuals who are more likely to drink to cope when under stress).

Personality/temperament theory

• unconscious motives for alcohol and drugs

• may reflect the influence of intensely emotional experience during infancy/early childhood

• use drug to achieve immediate oral gratification and pleasure may stem from arrested development or fixation at the oral stage of development

• however no evidence to support alcoholic personality

• evidence proposed classifications of alcoholism including

• 1. Introversion–extraversion

• 2. milieu-limited alcoholism (Type 1) vs Male-limited alcoholism (Type 2)

• 3. Type A and Type B alcoholism

Extraversion & alcohol

higher associated with increased alcohol use dye to greater social engagement, reward sensitivity, and sensation-seeking

Introversion & alcohol

not a strong risk factor for alcoholism

some may develop problematic drinking when it is used to cope

Types of alcoholism

The enhanced reinforcement model

Having a greater predisposition to sensitivity to AOD

AOD functions as reinforcers in reducing stress (for individuals without good psychological coping skills)

The negative affect model

using AOD as a form of self medication

suffering from depression or anxiety, combined with stressful life events and having poor coping skills

Zinburg’s DIE model of drug experience (Zinburg, 1984)

aka Drug, Set and Setting Model

To understand behaviours of drug users we must look into factors relating to not only the Drug itself but also the Individual and Environmental/social factors

Zinberg’s theory and harm minimization

Offers one of the most useful and practical means to reduce the negative consequences of substance use, especially in harm minimization approaches with substance users.

E.g. someone may reduce harm by making sure they eat before drinking (Individual) or only drink in the company of others (Environment).

Or someone may share that they used less drugs when employed, reflecting that:

• They may feel better about themselves (Individual) when they are spending more productive time at work (Environment).

• They may also make new and nonsubstance abusing friends at work (Environment).