HLTHAGE 1CC3 Test 2

biomedical model of addiction

- addiction as a chronic brain disease

- neurochemical changes in dopamine and reward pathways

- genetic vulnerability and loss of control

- lifelong condition requiring management

strengths of the biomedical model of addiction

- reduces shame and moral judgement of others

- methadone became more socially acceptable

- encouraged funding and insurance coverage

- supported medication-assisted treatment

- recognizes withdrawal and detox as medical needs

concerns of the biomedical model of addiction

- individualizes the problem

- ignores trauma, poverty, racism and colonization

- encourages compliance over agency

- focuses on symptom management rather than root causes

moral/criminal lens of addiction

- addiction as deviance, sin, crime

- punishment and incarceration

- abstinence framed as moral requirement

the war on drugs

attempted to end the international trade in drugs by directing military and police resources towards eliminating trade and consumption of drugs

no evidence that rates of addiction were reduced

how does society use the moral/criminal lens of addiction

comparing neighbourhoods and society's approach:

- predominantly black areas are arrested / treated as criminals

- predominantly white areas are medicalized

how have other countries reduced addiction rates

Portugal and Switzerland have both implemented some form of decriminalization with, overall, positive public health and economic results

Alcoholics Anonymous and the 12 Step Process

1935: Bill Wilson and Dr. Bob Smith

AA developed in response to the moral model/criminalization of addiction

recognized addiction as a disease (premodern medical model) and also understood addiction as a psychosocial problem

AA and similar groups (Narcotics Anonymous) have become the predominant narrative of treatment and recovery for addiction

AA suggests that actions such as prayer, self-reflection, and self-improvement are ways to help oneself heal from addiction

the model has been adopted for a wide variety of addictive substances and behaviours (AA, NA, CA, MA, etc)

psychosocial lens of addiction

- addiction as coping and survival strategy

- rooted in trauma, attachment, and environment

- focus on meaning, context, and function of substance use

strengths of the psychosocial lens of addiction

resorts dignity and agency

trauma-informed and context-aware

supports therapeutic alliance and skill-building

limitations of the psychosocial lens of addiction

- may underplay biological withdrawal and craving

- may overemphasised insight and therapy

- can overlook immediate physiological needs

- tapering - slowly decreasing the amount of substance use overtime

harm reduction model of addiction

- focus on safety rather than abstinence

- meeting people where they are

- needle exchange, safe supply, supervised consumption

structural/critical social lens of addiction

- addiction linked to poverty, homelessness, racism, and colonization

- systems and policy as drivers of harm

- advocacy and systemic change as intervention

feminist and care ethics lens of addiction

gendered trauma and stigma

relational vulnerability and unmet care needs

addiction as relational distress

unhelp to immediately dive into trauma

indigenous and decolonizing perspectives of addiction

addiction as impact of colonization and cultural rupture

healing through reconnection, culture, and community

why should we hold multiple lenses of addiction? what are the dangers of the single lens approach?

no single model is sufficient, people live at the intersection of biology, trauma and structure

overmedicalizing, over-therapizing or over-criminalizing, ignoring power and context leads to harm

treatment options for addiction

- therapies for addiction have evolved alongside theories of addiction

- medical explanations correspond to medical treatment, including detoxification and institutionalization

- psychological explanations corresponded to therapy

- modern approaches include CBT which is used to address the addictive behaviour directly

- other therapeutic approaches might include, in addition to MET, SBNT and work to address underlying problems such as depression and trauma

- in the 1950s researchers investigated therapeutic use of psychedelic drugs, such as LSD, in the treatment of addiction

- there is research being conducted now using LSD and psychedelic mushrooms to treat PTSD and Chronic Pain/illness

who is more likely to experience addiction

people with trauma histories and histories of adverse childhood experiences

medication used for addiction

medications used in the treatment of addiction include Opiate Replacement Therapy (ORT) (i.e. methadone or buprenorphine for the treatment of opiate addiction)

prescription heroin is also sometimes used in the treatment of heroin addiction

detoxification in conjunction with drug antagonists may be used

addiction

repetitive consumption of a substance or repetitive engagement in an activity that is considered problematic

inbreity

"disease of the nervous system characterized by a morbid craving"

term developed at the end of the 19th century

disease model of addiction

understands addiction as a predisposition within certain individuals

result of their nervous system, historically described with terms such as alcoholism, dipsomania, habitual drunkedness

reinforced idea that there was something wrong with the individual, either in metabolism or will

addiction related to the broader idea of individual degeneracy

temperance movement

19th century, identified the main problem with addiction as the drug itself

members of the temperance organization pushed for restrictions on availability and consumption of alcohol

dependence

encompassing tolerance (the idea that one needs more of a substance to achieve the same effect)

withdrawal

set of unpleasant symptoms, ranging from headaches to hallucinations, that people experience when they stop using substances

how many Canadian women aged 15-24 had an eating disorder in 2002?

1.5%

which psychiatric illness has the highest mortality rate

anorexia nervosa

10% die within 10 years of onset

people with anorexia nervosa have a ________ year reduction in life expectency

20-25

how have body ideals changed overtime?

in renaissance Europe people preferred fuller bodies as it represented fertility, wealth and health

in the 2000s "heroine chic" was preferred - extremely thin bodies

in the present day hourglass figures are preferred

anorexia nervosa diagnostic criteria

over a period of at least three months

behaviours such as food restriction, purging, misuse of medications, over-exercising, which interfere with maintaining an adequate weight for health

powerful fear of weight gain / becoming fat

overestimation of body size

denial of the seriousness of the condition

bulimia nervosa diagnostic criteria

food restriction, binging and purging at least once a week over a period of at least three months

people with bulimia often experience extreme feelings of shame and hide these behaviours

often people with bulimia are of average weight

bulimia is associated with depression, self-harm, suicidality

binge eating disorder

a new disorder introduced in DSM-5

consumption of an unusually large amount of food over a short period of time (different from overeating!)

person feels out of control about what they are eating, how much they are eating and when they are able to stop

considered a disorder when it occurs at least once a week for at least three months

avoidant restrictive food intake disorder (ARFID)

in the DSM 5

usually starts in infancy/childhood

involves unusual avoidance of particular types/textures/colours of foods

severe enough to impair adequate nutrition

if untreated, can lead to anorexia nervosa or bulimia nervosa in adolescence or adulthood

rumination disorder

in the DSM 5

consistent regurgitation of chewed and/or partially digested food over a period of at least one month

pica

in the DSM 5

persistent consumption of non-food items over a period of at least oe month (i.e paper, dirt, hair, chalk)

anorexia athletica

not yet recognized in DSM

over-exercise to the point of neglecting other priorities in life

exercise used to control body shape and weight

exercise used provide a sense of power, control, self-respect

orthorexia

not recognized in DSM-5

eating only foods perceived to be healthy

relying only on natural remedies for illness

finding more pleasure in following food rules than in the experience of the food itself

promoting a culture where people start to fear eating certain foods?

body dysmorphic disorder

classified in DSM-5 as an obsessive compulsive disorder

involves preoccupation with appearance, focusing on non-existent or minor flaws

often includes repetitive mirror checking, grooming rituals, etc

impairs daily functioning

treatment for eating disorders

early detection is important

treatment is often multi-disciplinary, nurses, psychologists, physicians, dieticians, etc

many different types of therapy may be used

treatment address both somatic and psychological symptoms

normalizing eating is a goal of treatment

people in treatment often need to gain weight- this is very challenging for a person with an eating disorder

concurrent treatment for other mental health disorders may be necessary

these are better understood as working in combination with one another, as an accumulation of risk, rather than as one sole cause of disordered eating

how do class and culture relate to eating disorders?

historically associated with white, middle class young women - this may be due to underreporting from other demographic groups

internalization of white, middle-class, western ideals of thinness may be a risk factor

risk factors for eating disorders

internalization of the ideal

body dissatisfaction plus internalization of socialized ideals of beauty, including a preoccupation with thinness, may be a risk factor

social media:

combines media and peers and has strong effect on eating behaviours

social media use is associated with other risk factors for eating disorders, such as weight and shape concerns and idealization of thinness

childhood maltreatment

parental and peer treatment

perfectionist tendencies

there is a strong genetic component although no gene has been identified as responsible - parents' opinions and behaviours influence their children's viewpoints

core arguments of Amy A. Ross Arguedas "Diagnosis as a Subculture"

orthorexia functions not just as a medical label, but as a subcultural identity and collective tool that both, seeks medical legitimacy for suffering

what does the orthorexia community demonstrate (diagnosis as a subculture reading)

shared identity ("we who have been harmed by wellness culture")

shared vocabulary (i.e "fear foods, food freedom, unlearning clean eating")

collective norms and practices

mutual recognition and validation

healthism

the moralization of health as personal responsibility

sports pressure to eating disorders

sports which emphasize appearance, size, weight and shape are risk factors for athletes (wrestling, gymnastics, diving, body building)

sports emphasizing individual performance also increases risk dance, running, figure skating)

sports which emphasises low body weight (track and field) increases risk

elite athletes, particularly female athletes in aesthetic sports are at particularly high risk

"positive body image"

exists independently of negative body image, you can experience both simultaneously

a core concept is body appreciation, bodies are more than appearance, there is also function and health

disentangles the association of self-worth with appearance

requires media literacy - understanding that the images in media are manipulated and fabricated

clinicians focus on promoting body appreciation, gratitude, self-care, etc, focus on what body does, rather than how it looks

Ozempic, Wegovy, Mounjaro (GLP-1 receptor agonists)

blurs the line between treatment and enhancement

originally developed for type 2 diabetes, now widely prescribed (ad sought) for weight loss

three core domains of ADHD

inattentive, hyperactive, impulsive

inattention aspect of ADHD

Difficulty sustaining attention

Careless mistakes/inattention to details

Easily distracted

Forgetful in daily activities

hyperactivity aspect of ADHD

fidgeting/difficulty remaining seated

Feeling "on the go"

Excessive talking

impulsivity aspect of ADHD

Interrupting others

Difficult waiting one's turn

Blurting out answers

in order to diagnose ADHD symptoms must be:

Persistent

Developmentally inappropriate

Impairing

Present across multiple settings

important clarifications of ADHD

Aggression is not a core diagnostic feature

Sleep disturbances is not part of the diagnostic criteria

Prevent us from overgeneralizing the diagnosis

prevalence and diagnosis of ADHD

approx 5% of children worldwide

prevalence varies across countries and regions

higher diagnosis rates in north america than in many European countries

influenced by screening practices, healthcare access, and cultural expectations

diagnosed by psychologists, psychiatrists, pediatricians

historical evolution of ADHD

mid-1960s: formal recognition of hyperkinetic behaviour

1968 (DSM-II): "Hyperkinetic Reaction of Childhood"

1980 (DSM-III): "Attention Deficit Disorder" (with/without hyperactivity)

shift from motor overactivity

attentional processes

criteria refined across subsequent DSM editions

biomedical lens of ADHD

neurodevelopmental disorder

executive dysfunction

symptom clusters

impairment criteria

evidence-based treatment

critical/sociological lens of ADHD

medicalization

diagnosis expansion

normalization

institutional power

pharmaceutical influence

how do power and institutions shape ADHD

schools shape what counts as "impairment"

diagnostic categories regulate behaviour

pharmaceutical systems influence treatment pathways

ADHD linked to broader productivity norms

diagnosis can both empower and stigmatize

modern classrooms require sustained attention

emphasis on productivity and standardization

behaviour interpreted through institutional norms

ADHD may reflect a mismatch between cognitive style and structure

not either/or - biology and environment interact

medication, treatment and pharmaceutical contexts of ADHD

stimulant medications are widely used in ADHD treatment

clinical trials demonstrate symptom reduction

pharmaceutical companies fund and produce medications

treatments guidelines shaped by research and regulatory systems

medication embedded in broader social and economic structures

digital media use and ADHD

heavy digital media use is linked to more ADHD symptoms over time

found in U.S adolescents (Ra et al, 2018)

Similar findings in Egyptian university students (Hassan et al, 2025)

important: studies show association, not proof of cause

examples of neurodeveleopmental disorders

FASD (fetal alcohol spectrum disorder)

motor disorders (i.e. tourettes syndrome)

communication disorders

genetically determined disorders (i.e. down syndrome)

conditions associated with traumatic/congenital brain injuries (i.e cerebral palsy)

symptoms of neurodevelopmental disorders

psychological symptoms/intellectual disability

physical symptoms (motor difficulties, cardiac defects)

physiognomic characteristics (i.e. particular facial features)

what two features do all neurodevelopmental disorders share

the idea that the root of such disorders is a neurological dysfunction that affects the individuals capacity for intellectual/emotional/social/physical development

'the fact that individuals diagnosed with such disorders often struggle to fit into society

in the DSM-5 what syndrome became grouped under autism spectrum disorder?

Aspergers

ritalin as treatment for ADHD

controversial

often sold illegally

drugs didn't work for 20% of children

dangerous side effects

other solutions like educational interventions often work better but are offered after medication

why might autism exist evolutionarily?

it may have had its advantages historically when humans were more isolated

personality

enduring patterns of thinking, feeling and behaving

relatively stable across time, shapes interpersonal functioning, exists on a continuum

DSM-5-TR definition of personality disorders

enduring, inflexible patterns

deviates from cultural expectations

onset in adolescence/early adulthood

distress of functional impairment

clusters A, B, C

cluster A personality disorders

paranoid personality disorder

schiziod personality disorder

schizotypical personality disorder

cluster B personality disorders

antisocial personality disorder

histrionic personality disorder

narcissistic personality disorder

emotionally unstable personality disorder (EUPD)

cluster C personality disorders

avoidant personality disorder

obsessive compulsive personality disorder

dependent personality disorder

biomedical model of personality disorders

Genetic vulnerability

Neurobiology

Trait expression

Heighted amygdala activation

Reduced prefrontal regulation

Serotonergic links to impulsivity

attachment and development model of personality disorders

Doesn't pathologize

Tries to understand where the problem originated and explores experiences

Early caregiving

Internal working models

Adult relational patterns

john bowlby

was the first "attachment theorist" that believed early bonds formed by children with their primary caregivers have significant impact throughout their lives

infants are born "hard wired" to attach as a method of survival

4 defining features of attachment (john bowlby)

safe haven

proximity maintenance

secure base

separation distress

arousal relaxation cycle

child feels discomfort (arousal) → child expresses discomfort (need) → parent attuned and feels tense → parent intervenes to meet child's need → child comforted and parent is relaxed

mary ainsworth

extended the work of bowlby and used the strange situation technique to assess attachment

discovered 3 styles of attachment: secure, insecure-avoidant, insecure ambivalent and later a 4th category: disorganised

secure attachment

child feels safe and protected, closeness to primary caregiver

child feels seen and known

child feels comforted, soothed and reassured

child feels valued

child feels supported to explore

insecure avoidant attachment

fears close proximity or intimacy, fears showing vulnerability, extreme rage or anger responses to confrontation or threat, expresses little or no empathy with others, little or no understanding of personal boundaries

insecure ambivalent

Lack sense of self and low self esteem

tendency to put other people's needs first, strong desire for relationship and intimacy, difficulty being alone, seeking approval and reassurance, clingy and needy behaviours in relationships, strong fear of rejection/criticism/abandonment

easily upset when receiving disapproval, jealousy and frustration when partner is unavailable or inattentive, overanalyzing and excessive worry about relationships, easily ignoring or misreading signs of relational issues

disorganized attachment

self centered, unresolved and unattended trauma, possible mental health and chemical dependency, difficulty regulating emotions/behaviour/thoughts, difficulty with consistency, structure and guidance to their own children, inability to be sensitively attuned, overwhelmed with guilty, ruminative, disconnected from own children

how does trauma related to personality disorders

childhood abuse and neglect cause chronic relational trauma, identity disruption and emotional regulation adaptations

what structural determinants relate to BPD diagnosis

poverty and housing instability

colonization and systemic racism

gender based violence

chronic environmental stress

historical control of women's emotions

Diagnosis as social regulation

"Hysteria" and emotional excess

Pathologizing women's anger and sexuality

Psychiatry within patriarchal systems

Hysteria fades from the DSM in the mid-20th century but BPD emerges and is disproportionately diagnosed in women

elizabeth packard

Committed to Illinois State Hospital (1860)

Institutionalize by husband for "religious disagreement"

Diagnosed under concept of "moral insanity"

No legal right to contest confinement

Later became a metal health reform advocate

feminist relational reframing of BPD

"what is wrong with her" to "what happed to her"

trauma informed reinterpretation

Rachel's story - Living With BPD

diagnosed in an inpatient unit

her main symptom was emotional instability

her health concerns were ignored due to her being a woman

after rejection she experienced a mixed episode of acute stress reaction and transient psychotic episode

barbiturates and amphetamines

Barbiturates and amphetamines were the most widely used substances by the 1950s in the US, accounting for 25% of all prescriptions

These were not thought of as psychiatric drugs

The public appetite for these revealed a market and profit motive for the manufacture and sale of substances thought to be relatively safe, despite high rates of barbiturate overdose

psychopharmaceutical revolution

Following WW2, psychoactive drugs began to be described as psychiatric medications

A number of new psychoactive medications became available (thorazine, MAOIs, tricyclic antidepressants)

Anti-anxiety medications, such as Miltown, claimed to treat anxiety without the risks of barbiturate medications

miltown

marketed as an anti-anxiety medication, was the first "blockbuster" psychopharmaceutical medication, with huge sales and initially, a reputation for being safe and non-addictive

disease mongering

Pharmaceutical companies increasingly shifted from marketing specific medications toward selling the idea of disease to consumers

Some critics point to the medicalization of normal human experience and diversity i.e. shyness became characterized as social anxiety

Drugs that are profitable and sought out by consumers became widely prescribed by physicians

feminism and the valium panic

Valium in the 1970s was the most prescribed drug

Increasing numbers of American women experienced overdose and substance dependence related to Valium

Feminists argued that Valium was being prescribed to women for conditions that were social problems - fatigue, nervousness, anxiety, rather than mental illnesses

These concerns led to changes in the regulation and marketing of Valium

drugs for life (Dumit) main arguments

Pharma does not simply treat disease, it helps define disease

Expansion form illness → risk → pre-risk

We become "patients-in-waiting"

Encouraged to see oneself as "potentially ill"

Health reframed as lifelong pharmaceutical management

what three frameworks are used to help make sense of what is observed clinically

consensus statements (treatment guidelines, developed by experts to resolve controversial questions about public health)

evidence-based medicine (ranks medical knowledge according to level of evidence, large clinical trials are the highest level level of authority)

casual reasoning/pharmacological reason (process where physicians consider a patient's response to medication)

acute drug treatment

treatment is intended to be brief and will end when symptoms end

chronic drug treatment

treatment may be long term, even life long

maintenance therapy

The use of medications to prevent future illness

Often used for people diagnosed with MDD, BD, Schizophrenia

A disadvantage of this approach is that it labels the people using these medications as chronically, permanently ill

Discontinuation trials are used to determine when and how people can stop using maintenance therapies

critical suicidology

Suicide can be understood through western science and an objective lens

Obscures the impact of lived experience and marginalization

Suicide is individual and should be treated as individual

Community driven and a wholistic approach to suicide actually works better for treatment

how do hospitals harm suicidal patients?

Only 5 of 240 suicidality survivors said that going to the hospital helped. There was poor facilities and isolation (up to 48 hours) which does more harm than good.

Area of concern is that there is a use of force amongst police who try to respond to suicidal patients

People are most suicidal after leaving in-patient treatment

In-patient units were found to be distressing

what are modern assumptions of suicide?

Suicide intervention should be informed by medical science

Suicide is irrational

Social worker as expert

Life is always better than death