Lecture 5 - Drugs and Alcohol

Definition of Addiction

repeated and continuing failure to refrain from or radically reduce the behaviour despite prior resolutions to do so

Models of Addiction

1. 17th century - moral model (addicts = weak willed and deserve punishment)

2. 20th century - disease model (people with an addiction = victims and need medical treatment)

3. 1970s - behavioural reinforcement and social learning

4. biopsychosocial model - brings together biological, psychological and social factors to understand the formation and maintenance of addiction

How common is addiction?

30-40% for nicotine

20% for alcohol

10% for cocaine

10% for ampetamines

Cost of addiction to society?

1/6 deaths due to alcohol and drugs

1/5 deaths attributed to cigarettes

Misuse of Drugs Act (1971)

established criminal offences for a range of activities including possessing, supply and production of specified ‘controlled drugs’

drug classification was created - class A (cocaine, ecstasy), B (cannabis, ketamine) or C (steroids)

classification not based on harm

What prevents users from seeking help?

Stigma and Fear

self-inflicted, internalised shame and self loathing

incontinence - signs of wetting and find this embarrassing or degrading

Why should classification not be increased?

possible delaying of treatment seeking and decriminalisation of possession combined with referral to health services

Summary

improve public and professionsal understanding of use

crete appropriate and specific services

enable users to access helps by reducing fear and stigma

Behavioural Reinforcement Theory

internal and external cues are the conditioned stimulus paired with the drug

drugs also positive reinforcer

modelling of others behaviours

Brain Disease Model

exposure to specific cues - hijacking of attention and memory mechanisms b cues

increased amygdala nad hippocampus activation (cue induced cravings)

Biopsychosocial Model

social risk factors combined with biological and psychological risk factors

Prevention of Addiction

1. doctors advice

2. public education

3. restrict advertising

4. increase the costs of drugs

5. restrict drug use

Treatments of Addiction

1. moral = punishment

2. medical = medication to help with withdrawal then abstinence

3. learning = reduce positive drug effects and increase negative one to replace associations

4. treatment addressing complex causes (eg comorbility)

Contingency Management

medication blocks drug binding sites

highlight negative aspects of drug taking and positive aspects of drug-free life

conditioned adversity

abstinence is rewarded with vouchers for recreation

Control Craving

cue avoidance (high risk situations)

cue exposure - relaxation

coping with cravings - urge surfing (mindfulness)

antidepressants

What is the big problem in seeking treatment?

motivation:

many addicts are in denial

ambivalent due to positive effects

resolved by motivational interviewing

Dealing with complex causes

use CBT

recognising thinking biases and underlying belief

identifying high risk situations and triggers

problem solving skills

activity scheduling and goal setting