Lecture 1b Introduction to Biological and Psychosocial Factors in Addiction

Introduction to Biological and Psychosocial Factors in Addiction

This course is coordinated by Dr. Andrea Palensov, a Senior Lecturer in Addiction Studies and Pharmacology at Adelaide University. The introductory session establishes the foundational concepts of addiction, distinguishes it from common usage of the term, and outlines the complex interplay of biological, psychological, and social factors that contribute to substance use disorders.

Defining Addiction and Common Terminology

In everyday language, the term "addiction" is used loosely to describe strong habits or preferences. Common examples include:

• Morning coffee consumption (e.g., "I wouldn't survive the day without it").

• Shopping habits.

• Technology and media consumption (e.g., "binging" a TV show made possible by streaming services).

However, professional and clinical contexts require more precise terminology. The use of alcohol and other drugs for non-medical purposes is categorized using several specifically defined terms, although they are often used inconsistently in public discourse:

• Misuse and Abuise.

• Unsanctioned use.

• Hazardous and harmful use.

• Risky use.

• Dependence vs. Addiction.

The Spectrum of Addictive Subjects

Addiction is not limited to illicit substances. The course explores the boundaries of what can be considered an addiction, questioning whether the following can be categorized as such:

• Food and nutrients: Sugar (notably an essential part of life) and chocolate.

• Behaviors and Technology: Shopping, the Internet, and mobile phones.

• Substances: Alcohol and drugs.

Distinguishing Addiction from Frequent Use

A central question in addiction studies is determining when a frequent behavior transforms into an addiction. Frequency alone (doing something every day or multiple times a week) does not necessarily constitute an addiction. For example, many people consume a cup of coffee daily without being classified as "addicted" in a clinical sense.

The Concept of "Alcoholism"

Dr. Palensov notes a preference for avoiding the term "alcoholic" (common in American literature) because it defines an individual solely by their behavior and substance use. This terminology often contributes to stigma and discrimination by overlooking the person in favor of the substance.

The Key Differentiator: Loss of Control

The definitive characteristic of addiction is a loss of control. This involves:

• Changes in Motivation: The behavior or substance becomes the primary focus of the individual's life.

• Displacement of Other Activities: Previous priorities and responsibilities are pushed to the periphery as attention shifts to obtaining or using the substance/performing the behavior.

• Unsuccessful Attempts to Quit: Persistent, failed efforts to reduce or stop the behavior signify a breakdown in control.

• Compulsive Use: Use continues despite an awareness of negative consequences.

Biological Adaptation: Tolerance, Withdrawal, and Craving

True addiction involves physical and biological changes in the brain and body.

The "Kiwi and Nuggets" Animation Model

The course utilizes a well-known animation (featuring a Kiwi bird and a substance called "Nuggets") to illustrate the progression of addiction:

1. Initial Curiosity: The subject tries a substance out of curiosity.

2. Euphoria/Psychoactive Effects: The initial experience is pleasant (represented as flight for the Kiwi).

3. The "Come Down": Following the high, the subject experiences negative physical impacts (hitting the ground hard).

4. Tolerance Development: With repeated use, the "high" becomes less intense and shorter in duration ($not flying as high$). The subject requires more of the substance or experiences less reward.

5. Physical Dependence: Eventually, the subject no longer uses the drug for euphoria but simply to feel "normal." This state is characterized by needing the drug to function and avoid the pain of withdrawal.

The Continuum of Drug Use

Drug use exists on a spectrum; not everyone who uses a substance will become addicted. The stages include:

1. Experimental Use: Infrequent or occasional use based on opportunity and availability.

2. Purposeful Use: Deliberate use for a specific effect (e.g., using stimulants/amphetamines to work longer hours).

3. Intensive Use: Increased frequency and volume of use.

4. Addiction/Compulsive Use: Characterized by the biological adaptations of tolerance and withdrawal, coupled with total loss of control.

Distinction Between Dependence and Addiction

A critical clinical distinction is made between physical dependence and addiction. For instance, a patient taking chronic opioids for severe pain management may be physically dependent (experiencing withdrawal if they stop), but if they maintain control and use the medication as prescribed, they are not necessarily addicted.

Statistical Overview of Drug Use in Australia

According to the National Drug Strategy Household Survey (reported by the Australian Institute of Health and Welfare approximately every $3$ years), a significant portion of the population does not engage in high-risk behavior.

• Non-Risky Population: Approximately $61\%$ of the Australian population engages in no risky drinking, illicit drug use, or smoking.

• Risky Drinking Definitions:

  • Consuming more than $2$ standard drinks per day on average.

  • Consuming more than $4$ standard drinks in a single session at least once per month.

• Smoking: Daily smoking is considered risky and usually indicates nicotine dependence/addiction.

• Illicit Drug Use: Defined as any use of at least $1$ illicit drug in the past $12$ months. While a single use of cannabis in $12$ months does not equal addiction, it is categorized as "recent use" in high-level data.

The Biopsychosocial Model of Addiction

Attributing addiction to a single cause is inaccurate. It is governed by a complex "Biopsychosocial Model" that includes several domains of influence:

1. Biological Factors

• Genetics: Multiple genes influence vulnerability to addiction due to the complexity of the brain areas involved.

• Epigenetics: How environmental influences change the way genes are expressed.

• Individual Personality/Neurobiology: Traits like impulsivity, novelty seeking, and cue reactivity (how the brain responds to triggers).

2. Psychological Factors

• Changes in brain mechanisms that govern the transition from "choice behavior" to "compulsive behavior."

• Motivation and cognitive control mechanisms.

3. Environmental and Social Factors

• Stress: Biological stress pathways triggered by external environments.

• Peer Use: Influence of social circles on drug initiation.

• Availability: How easy it is to obtain the substance.

• Environmental Influences: Both positive and negative factors in the subject's surroundings.

Course Structure and Objectives

The study of addiction is divided into two distinct semesters:

• Semester 1 (Current): Focuses on the biological and psychological factors of addiction. It unpacks the brain mechanisms, genetic vulnerabilities, and psychological drivers of the condition.

• Semester 2: Focuses on the treatment and management of addiction. This includes clinical interventions, primary prevention (preventing the start of use), and secondary prevention (early intervention for those at risk).

Questions & Discussion

Q: Do you think we can be addicted to shopping, chocolate, the Internet, or mobile phones?

A: Dr. Palensov suggests that while these are often frequent behaviors, the label of "addicted" applies when they result in a loss of control. There are indeed individuals for whom shopping becomes a compulsive addiction. The course will continue to explore whether substances like sugar—which are essential for life—can truly fall under the umbrella of addiction in the same way as alcohol and drugs.