PSYC 223 - Theories of Substance Use Disorder

Function of assessing the risk and protective factors that contribute to substance use disorders

Helps practitioners select appropriate interventions

What does effective prevention of substance use disorders focus on?

• Reducing risk factors and strengthening protective factors that are most closely related to the problem being addressed

What kinds of risk and protective factors should especially be targeted in prevention efforts?

Those that have the potential to produce positive effects in multiple areas

Over ____ substance use disorder theories exist

43

Why is a representation of the broader set of risk and protective factors important?

Factors related to substance use co-occur

Risk factors

characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes

Protective factors

characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor’s impact (positive countering events)

2 categories of risk and protective factors

1. Fixed - don’t change over time

2. Variable - do change over time

4 examples of varaible risk and protective factors

1. Income level

2. Peer group

3. Employment status

4. Adverse childhood experiences (ACEs)

2 examples of individual-level risk factors

1. Genetic predisposition

2. Addiction or exposure to alcohol prenatally

3 examples of individual-level protective factors

1. Positive self-image

2. Self-control

3. Social competence

5 factors contributing to multivariable theories of Evolutionarily Significant Units (ESUs)

1. Cognitive affect

2. Conventional commitment and social attachment

3. Social learning

4. Social ecological model

5. Intrapersonal characteristics

2 aspects of cognitive affect theories

1. Attitudes and beliefs

2. Intentions

2 aspects of conventional commitment and social attachment theories

1. Emotional attachment to peers

2. Strain (i.e. perceived life chances)

2 aspects of social learning theories

1. Intrapersonal relationships that inform beliefs

2. Social relationships that inform beliefs

2 aspects of social ecological model theories

1. Stress

2. Self-esteem

4 aspects of intrapersonal characteristics theories

1. Impulsivity

2. Risk-taking

3. Lack of coping skills

4. Social interaction

5 aspects of integrative theories

1. Cognitive affect

2. Learning

3. Commitment

4. Attachment

5. Interpersonal constructs

4 types of risk/protective factors

1. Individual/peer

2. Family

3. Community

4. School

3 individual/peer risk factors

1. Antisocial behavior

2. Genetics

3. Perceptions of peer marijuana use

3 individual/peer protective factors

1. Self-efficacy

2. Peer disapproval

3. Involvement in hobbies

3 family risk factors

1. Parental acceptance of substance use

2. Family conflict

3. Poor parent-youth relationships

3 family protective factors

1. Parental monitoring

2. Perceived parental trust

3. Restrictive parental rules

3 community risk factors

1. Widespread availability

2. Exposure to drugs in the community

3. New products that attract youth

2 community protective factors

1. Prosocial opportunities

2. Community norms that discourage youth use

3 school risk factors

1. Low policy enforcement

2. Out of school suspension

3. High absenteeism

3 school protective factors

1. School belonging

2. School involvement

3. Authoritative school environment

_________________ factors typically outweigh __________________ factors

protective and resilience, risk

Key fact about relationship between biology and substance abuse

• All people have biological and psychological characteristics that make them vulnerable to, or resilient in the face of, potential behavioral health issues

• These factors interacting within multiple contexts can influence their substance use disorder risk

What manner of treatment regarding risk and protective factors is unlikely to be successful? Why?

Targeting only one context when addressing a person’s risk or protective factors is unlikely to  be successful, because people don’ t exist in isolation

3 risk factors in societal context

1. Norms and laws favorable to substance use

2. Racism

3. Lack of economic opportunity

2 protective factors in societal context

1. Hate crime laws

2. Policies limiting the availability of alcohol

Key fact about the impact of individual risk and protective factors

Individual factors can be associated with multiple outcomes

2 outcome that negative life events are associated with

1. Substance use

2. Anxiety, depression, and behavioral health issues

Why are universal, selective, and indicated prevention interventions used in different contexts?

Not all people or populations are at the same risk of developing behavioral health problems, so prevention interactions should be matched to the population’s level of risk

Psychosocial health

• Basic traits of psychosocial health refers to how well as person;

  • Likes themselves

  • Accepts their mistakes

  • Takes care of themselves

  • Have empathy for others

  • Controls their anger, hate, tension, and anxiety

  • Are optimistic

  • Can work alone and with others equally well

What 4 aspects of health does psychosocial health combine

1. Mental health

2. Emotional health

3. Social health

4. Spiritual health

Foundation of Problem Behavior Theory

adolescents are prone to multiple problem behaviors

3 main systems that together contribute to psychosocial risk

1. Personality system

2. Perceived environment system

3. Behavior system

What can one’s psychosocial risk lead to according to the Foundation of Problem Behavior Theory?

Proneness to engage in a given behavior

3 aspects of the personality system of the Foundation of Problem Behavior Theory

1. Values

2. Self-perception

3. Individual differences

2 aspects of the perceived environment system of the Foundation of Problem Behavior Theory

1. Peer pressure

2. Parental influences

2 aspects of the behavior system of the Foundation of Problem Behavior Theory

1. Problem behavior

2. Delinquency

3 factors that lead to proneness in the personality system

1. Lower value on academic recognition

2. Higher value on independence

3. Lower religiosity

3 factors that lead to proneness in the perceived environment system

1. Lower compatibility between parent and friends’ expectations

2. Greater perceived influence from friends than parents

3. Greater friends approval for problem behavior

3 factors that lead to proneness in the behavior system

1. Greater involvement in proto-delinquent behavior

2. Greater involvement with marijuana use

3. Less attendance at church

What did the Problem Behavior Theory introduce?

Levels of causation and problem behavior

3 levels of causation according to PBT (environment)

1. Individual

2. Proximal: social and risk-taking behaviors of peers/family

3. Distal: attachment to peers/family

3 levels of causation according to PBT (individual)

1. Proximal: personal control, attitudes toward deviant behavior, decision in the moment

2. Intermediate: motivation instigations, goal orientation, expectations, values on peers/family

3. Most distal: personal beliefs, cultural alienation, self-esteem

Modern Problem Behavior Theory

Risk and protective factors → adolescent risk behaviors/lifestyles → health/life-compromising outcomes

5 categories of influences (risk and protective factors) outlined in the modern problem behavior theory

1. Biology/genetics

2. Social environment

3. Perceived environment

4. Personality

5. Behavior

3 adolescent risk behaviors/lifestyles outlined in the modern problem behavior theory

1. Problem behavior

2. Health-related behavior

3. School behavior

4 health/life-compromising outcomes outlined in the modern problem behavior theory

1. Health

2. Social roles

3. Personal development

4. Preparation for adulthood

Goal of the Jessor et al. 1987 study

to determine whether protective factors and risk factors interact

4 characteristics of the sample population used in the Jessor et al. study

1. Males and females followed from 1969

2. Ages 13-15 (N = 589)

3. Peak ages at the last assessment 25-27 (483)

4. Total of 482 individuals participated at all assessments

4 measures used in the Jessor et al. study

1. Problem drinking (frequency of drunkenness)

2. Marijuana use

3. Sexual deviance

4. Aspects of PBT framework

Analytical method used in the Jessor et al. study

Correlations derived via regression

How can correlation values be interpreted?

By looking at the number itself or a scatterplot

What does the size of a correlation value indicate?

Degree of interdependence between the variables

Negative sign of a correlation value

indicates that as the first variable increases, the second variable decreases

Positive sign of a correlation value

indicates that as the first variable increases, the second variable increases

Correlation value of zero

No relationship

According to Jessor et al., what 3 behaviors increase as problem drinking increases?

1. Marijuana use

2. Amount of non-virgins

3. Deviance

According to Jessor et al., what behavior decreases as problem drinking increases?

Church attendence

How is drinking behavior related to problems and conventional behaviors according to Jessor et al.?

• Conventional behaviors are all negatively correlated with proneness to problem behaviors

• Problem behaviors are all positively correlated with proneness to problem behaviors

What is the main conclusion of the Jessor et al. study?

Shows support for Problem Behavior Theory

2 familial effects that put students at a greater risk of initiating alcohol or drug use in college, or at an earlier age

1. Family history of internalizing problems

2. Family history of substance abuse

What negative behavior is religiosity negatively associated with?

Binge drinking

Theory of Triadic Influence

It was proposed to acknowledge numerous behavioral influences and to provide a structured and testable integrated theory

How was the theory of triadic influence organized into a 3×3 framework?

3 levels of causation and 3 streams of influence

3 levels of causation of the theory of triadic influence

1. Ultimate causes

2. Distal influences

3. Proximal predictors

3 streams of influence of the theory of triadic influence

1. Personal stream

2. Social stream

3. Environmental stream

3 types of ultimate causes of the theory of triadic influence

1. Biology/personality

2. Social situation

3. Cultural environment

Ultimate-level causes of the theory of triadic influence

broad and relatively stable factors that the individual has very little control over

Effects of ultimate-level causes in the theory of triadic influence

Their effects are the most pervasive, the most mediated, and the most difficult for any one person to change

4 examples of ultimate-levels causes in the theory of triadic influence

1. Politics

2. Religion

3. Socioeconomic status

4. Media

Distal-level causes in the theory of triadic influence

variables that an individual is likely to have some control over

2 types of distal-level causes in the theory of triadic influence

1. Quality and contact with individual

2. Evaluations and expectancies of one environment

4 examples of distal-level causes in the theory of triadic influence

1. General self-control

2. Bonding to parents

3. Religious participation

4. Expectations from working hard in school

Proximal-level causes in the theory of triadic influence

immediate precursors of a behavior that are directly under the control of the individual

What 2 factors may moderate proximal-level causes in the theory of triadic influence?

1. Distal factors

2. Ultimate factors

3 examples of proximal-level causes in the theory of triadic influence

1. Decision to have a drink

2. Intention to go to church

3. Experiences that have a direct influence on the behavior

3 types of prevention interventions

1. Universal preventive interventions

2. Selective interventions

3. Indicated preventive interventions

Universal preventive interventions

take the broadest approach and are designed to reach entire groups of population

3 environments that universal preventive interventions may target

1. Schools

2. Whole communities

3. Workplaces

Selective interventions

target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population

Example of a selective intervention

Peer support group for adults with a family history of substance use disorders

Indicated preventive interventions

target individual who show signs of being at risk for a substance use disorder

2 examples of indicated preventive interventions

1. Referral to support services for young adults who violate drug policies

2. Consultation for families of older adults admitted to hospitals with potential alcohol-related injuries

Rates of drug and alcohol disorders are generally in what 6 groups?

1. Males

2. Individuals who initiate use prior to age 12-15 (depending on the substance)

3. Groups from lower educational history

4. Unmarried individuals

5. Individuals from a low income background

6. Individuals with social disadvantages

Effective prevention programs aim at reducing risk factors such as…(4)

1. Aggression (including intimate partner violence)

2. Delinquency

3. Influences from delinquent peers

4. Impulsive-like behaviors

Effective prevention programs aim at increasing protective factors such as…(5)

1. Parent relationships

2. Relationships with other adult role models

3. Self-esteem

4. School affiliation

5. Prosocial recreational activities

Effective prevention programs assume the validity of what hypothesis?

Assume the validity of the gateway hypothesis and thus focused on alcohol and/or tobacco prevention

Effective prevention programs are ___________ and ___________ sensitive

developmentally, socioculturally

3 ways that effective prevention programs may develop social skills among youth

1. Develop general interpersonal social skills to increase positive and prosocial experiences in social settings

2. Build coping skills to address peer pressure to use drugs

3. Socialize youth to engage in social activities not involving drug use and related delinquent activities

What component of prevention programs is especially focused on discipline and support?

Parent component

Why can a parent component of a prevention program be helpful?

Parental and caregiver behaviors and practices have a large impact and perhaps exert the most significant and pervasive influence over the health behaviors of adolescents

Discipline behaviors include activities to help parents…(7 things but do not have to name them all)

1. Improve adaptive parental coping strategies

2. Strengthen parental involvement

3. Identify appropriate monitoring and supervision

4. Establish concrete and realistic expectations of children’s behaviors

5. Implement behavioral skills to reduce conduct problems in children

6. Emphasize the importance of consistent and appropriate discipline and rule-making

7. Recognize the importance of monitoring children’s activities

Support behaviors include activities to help parents…(5 things but do not have to name them all)

1. Promote family togetherness and solidarity

2. Spend quality time with children

3. Express sincere interest in children’s hobbies and schoolwork

4. Display child advocacy behaviors and attitudes

5. Incorporate positive reinforcements, such as increasing responsibilities and privileges