Chapter 1: Drug and Behaviour Pharmacology

Overview of Drug Pharmacology

• Pharmacology: The scientific study of drugs concerning all information about the effects of drugs on living systems.

• Psycho-pharmacology: A subarea of pharmacology focused on the effects of drugs on behavior.

Defining Drug Use and Abuse

• Drug: Broadly defined as any chemical entity or mixture of entities that is not required for maintaining health but alters biological function or structure when administered.

• Drug Use: Any use of drugs that causes physical, psychological, legal, or social harm to the individual user or others affected by the drug user’s behavior.

• DSM-5 Criteria:

  • Dependence: A strong compulsion or urge to take a drug.

  • Types of Dependence:

  1. Physical Dependence: The body adapts to the drug, requiring increased amounts for the same effects.

  2. Psychological Dependence: Strong emotional or motivational need for the drug.

  • Drug Dependence:

  • Increased amount needed for intoxication.

  • Diminished drug effect with the same amount used.

• Cross Tolerance: Tolerance developed for one drug can lead to tolerance for similar drugs due to biological factors.

• Withdrawal: A definable illness that occurs with the cessation or decrease in drug use, characterized by withdrawal symptoms.

The Drug Experience

• Research Findings: The drug experience is influenced by more than just the drug's pharmacological action. Key Factors include:

  1. Pharmacological Factors

  2. Characteristics of the Drug User

  3. Social and Environmental Factors

Pharmacological Factors

• Drug Dosage: A measure of the quantity of a drug consumed.

• Route of Drug Administration: The method by which drugs enter the body (e.g., oral or intravenous).

Psychological Characteristics

• Personality Traits Involved in Drug Use:

  • Sensation Seeking: A characteristic involving the need for varied, novel, and complex sensations and the willingness to take physical and social risks for the sake of experiences.

  • Addictive Personality: The hypothesis suggesting that particular personality traits are common among individuals with substance abuse disorders, though individuals with substance abuse problems show considerable personality variance.

• Drug Expectancies: The powerful influences of beliefs regarding drug experiences, based on expectations shaped by previous experiences with substances.

• Psychological Set: Refers to the knowledge, attitudes, expectations, and thoughts about how a substance influences drug experiences.

Social and Environmental Factors

• Influence: Social and environmental contexts play a significant role in shaping individual drug experiences.

• Alcohol Consumption Example: Alcohol is viewed as a recreational and social drug commonly associated with enjoyment and decreased inhibition.

Contemporary Issues in Drug Use

• Club Drugs: Associated with serious health problems and fatalities; some types are colorless, tasteless, and odorless.

• Polydrug Use: Occurs when individuals use multiple drugs concurrently.

• Drug Addiction: Defined as overwhelming involvement with a drug, characterized by a perceived need, tolerance, and a tendency to resume use after cessation.

Historical Context of Drugs

• Ancient Usage: The earliest recorded use dates back to 1500 BC, with an Egyptian scroll documenting 800 prescriptions for common ailments.

• Cultural Significance: Hallucinogens have historically been viewed as possessing spiritual powers, illustrating deep historical ties to cultural practices.

  • SOMA Example: Revered in the Rig Veda, this plant mixed with milk was essential for rituals and deities, emphasizing the connection between bodily experiences and spirituality.

Chapter 2: Theories on Addiction

Five Dimensions of Drug Use

1. Commencement: Reasons individuals start using drugs.

2. Maintenance: Factors sustaining drug-taking behavior over time.

3. Escalation: Mechanisms that intensify drug use.

4. Cessation: Processes involved in stopping drug use.

5. Recommencement/Relapse: Explanations for returning to drug use after a cessation period.

Moral Model of Addiction

• Conceptual Basis: Addiction is viewed as morally wrong and a result of weak moral character.

• Personal Responsibility: Individuals are held accountable for their drug use, suggesting recovery is achievable through willpower alone.

• Examples of Moral Model Initiatives:

  • Prohibition: Laws restricting drug use.

  • Drunk Tanks: Facilities for housing intoxicated individuals.

  • Anti-Smoking Campaigns: Aims to reduce tobacco use.

  • Random Drug Testing: Employment policies screening for drug use.

  • War on Drugs: Government efforts to diminish illegal drug trade and use.

War on Drugs

• Language and Labelling: The use of negative terms stigmatizes users, including labels like drunkard and junkie.

• Racial Associations: Different drug types carry racial connotations (e.g., cocaine vs. crack cocaine).

• Prison Population Rise: Increased incarceration rates related to drug offenses.

• Global Capital Punishment: Some nations enforce capital punishment for drug-related crimes, as seen in the Philippines.

Biological Theories of Addiction

• Disease (Medical) Model: Opposes the Moral Model, asserting addiction is a chronic disease needing medical intervention instead of moral blame.

  • Stigma Reduction: Emphasizes support and understanding rather than criminalization.

  • Illness Perspective: Views individuals with substance dependence as patients requiring treatment.

• Characteristics of the Disease Model:

  • Compulsive Behaviour: Users exhibit diminished control due to biological factors.

  • Genetic Variability: Hereditary predisposition to drug dependency which worsens with increased use.

• Critiques of the Disease Model:

  • Lack of Empirical Support: Insufficient evidence supporting addiction as a medical disorder.

  • Inconsistent Definitions: No consensus on diagnosing addiction as a disease.

  • Lack of Treatment Standards: Absence of standardized methods for addiction care.

Neurobiology of Addiction

• Brain Mechanism Alteration: Addiction is linked to changes in brain reward systems, enhancing compulsive behaviors.

• Dopamine's Role:

  • Function: Involved in reward mechanisms and behavioral motivation, forming new synapses.

  • Addiction Impact: Addiction alters dopamine metabolite levels, affecting synaptic networks.

• Dopamine and the Reward System:

  • Dopamine Imbalance Model: Affects pathways that regulate:

  • Reward processing

  • Motivation

  • Memory and Learning

  • Habit formation

  • Inhibitory control

  • Executive functions

  • Stress reactivity

  • Aversion mechanisms

Critiques of Neurobiological Theory

• Habit Formation: Changes in the brain are similar to those seen in habit formation instead of addiction.

• Reductionist Nature: Fails to explain why addiction mechanisms impact some individuals but not others.

• Causation Issues: Lacks comprehensive support for a causal relationship between addiction and physiological changes.

Genetics of Addiction

• Inherited Disorder: Some may genetically predispose towards substance misuse.

• Polygenic Factors: Current understandings view addiction as influenced by multiple interacting genes and environmental interactions.

Critiques of Genetic Theory

• Research Gaps: Genetics alone fails to adequately explain all cases of substance abuse.

• Environmental Considerations: Emphasizes the importance of including social and cultural factors in addiction understanding.

Brain Dysfunction in Addiction

• Chronic Abuse Effects: Prolonged substance use results in neurobiological differences between dependent and non-dependent users.

• Cognitive Impairment: Chronic drug use adversely affects memory, concentration, and impulsivity.

• Willpower Damage: Substances affect brain areas responsible for judgment and self-control.

Critiques of Brain Dysfunction Theory

• Recovery Evidence: Many individuals can achieve and maintain abstinence, challenging the validity of brain dysfunction as a sole addiction explanation.

Biochemical Theory of Addiction

• Underlying Biological Malfunctions: Views addiction as resulting from dysfunctional biological systems.

• Nutritional Influences: Certain dietary deficiencies and metabolic abnormalities, like hypoglycemia, may drive cravings.

Examples of Biochemical Influences:

• Hypoglycemia and Alcoholism: Demonstrates a reciprocal relationship.

• Inheritable Brain Chemistry: Children of alcoholics often show altered brain chemistry, increasing alcoholism susceptibility.

• Endorphin Levels: Low levels lead to heightened opioid responses.

• Environmental Toxins: Exposure to certain toxins increases addiction vulnerability.

Critiques of Biochemical Theory

• Need for Further Research: Proposed relationships require more empirical evidence for causation.

• Integration into Neurobiology: Biochemical insights are often absorbed into broader neurobiological explanations.

Psychological Theories of Addiction

Overview of Psychological Theories

• Behavioral Focus: Indicates drug dependency relates to individual behavior rather than strictly a disease aspect.

• Learning Mechanisms: Observations on how behavior is learned, reinforced, and adjusted through environmental feedback.

Learning Theory in Addiction

• Behavioral Changes: Grounded in principles of reinforcement, either negative or positive.

  • Pavlovian Conditioning: Involves pairing a conditioned stimulus (the drug) with an unconditioned stimulus (reward).

• Developmental Learning: Emphasizes repetition motivated by desires leading to profound learning.

• Social Learning Theory: Suggests that pleasure or the avoidance of negative consequences motivates continued drug use.

Personality Theory in Addiction

• Addiction and Personality Traits: Examines whether addiction influences personality or vice versa.

• Traits Associated with Drug Misuse: Include impulsivity, low frustration tolerance, and negative self-image.

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Personality Traits Breakdown

1. Extraversion: Talkative, lively, and risk-taking traits.

2. Agreeableness: Kindness and cooperativeness versus rudeness.

3. Conscientiousness: Organized versus sloppy or disorganized.

4. Emotional Stability: Variability from relaxed and easy-going to anxious and jealous.

5. Openness to Experience: Intellectual/philosophical versus uninquisitive.

Common Characteristics Among Users

• Traits Linked to Drug Misuse:

  • High emotional sensitivity

  • Impulsivity and reward-seeking

  • Low self-esteem

  • Relationship immaturity

  • Difficulty expressing anger

  • Excessive anxiety

  • Compulsiveness

Personality Theory Insights

• Diversity Among Users: No consistent pattern exclusively ties a personality to drug dependency.

• Attention-Seeking Behavior: Alcohol-dependent individuals often exhibit a desire for attention and reliance on others.

• Research Challenges: Difficulty establishing definitive correlations between traits and addiction susceptibility.

Psychodynamic Theory of Addiction

• Developmental Faults: Views addiction as a coping method for unresolved conflicts or deficits during development.

• Addictive Mechanism: Dependency is viewed as a means to manage internal conflicts, anxiety, and emotional regulation.

Humanistic Theory of Addiction

• Human Needs Framework: Based on Maslow’s hierarchy of needs impacting behavior.

• Dysfunctional Relationships: Addiction is seen as an unhealthy bond with substances, serving as an escape from suffering.

Critiques of Humanistic Theory

• Theoretical Weakness: Lacks empirical support and may oversimplify complex human needs.

• Ethnocentric Bias: Fails to account for cultural variations in responses and definitions of need.

Attachment Theory

• Conceptual Focus: Considers long-term emotional bonds.

• Secure Attachment Influence: Inadequate secure early attachments may correlate with a higher likelihood of substance use later.

Styles of Attachment (John Bowlby)

1. Secure

2. Ambivalent-insecure

3. Avoidant-insecure

4. Disorganized-insecure

Implications of Attachment Theory

• Addiction as Attachment Disorder: Insecure attachment may lead individuals to seek substances as stand-ins for emotional connections and security.

Rational Theory

• Knowledge Impact: Well-informed individuals likely make healthier substance-related choices.

• Long-term Perceptions: Many people falsely believe they are immune to long-term health issues related to substance use.

Educational Effectiveness

• Correlation with Usage: Educational efforts have shown trends of decreased drug and alcohol use.

• Inconsistent Messaging: Mixed messages in media can undermine educational initiatives and affect prevention efforts.

Sociological Theories of Addiction

Societal Context

• Influencing Factors: Research examines how societal practices contribute to drug use and addiction.

Cultural Theory in Addiction

• Shared Beliefs: Collective beliefs shape the understanding of drug use.

• Cultural Influence on Patterns:

  • Healing/medical practices (e.g., the use of morphine)

  • Regular customary consumption (e.g., coffee)

  • Special occasion use (e.g., alcohol during celebrations)

  • Excessive use leading to addiction.

Subcultural Theory of Addiction

• Specific Variables: Different subcultures significantly impact drug usage norms and acceptance.

• Perceptions of Substance Use: Substance use may be highly normalized in certain demographics, particularly younger people or specific social environments.

Marxist Theory of Addiction

• Economic Structures: Attributes addiction to sociopolitical frameworks leading to inequality and economic distress.

• Social Problems and Recovery: Links addiction to societal stressors, emphasizing that changes in the system are necessary

Availability-Control Theory

• Substance Access: Postulates a direct link between substance availability and the prevalence of substance-related issues.

• Impact on Dependency Rates: Increased average consumption correlates with burgeoning alcohol dependency rates.

Recommendations for Substance Control

• Policy Changes: Suggested actions include:

  • Increasing alcohol taxes.

  • Raising legal drinking ages.

  • Limiting the number of outlets selling alcohol.

  • Reducing sales hours.

  • Restricting advertising policies.

Environmental Stress and Substance Misuse

• Stressful Events Correlation: Experiences of life stressors are often linked to elevated substance use rates.

• Vulnerability Increase: Heightened environmental stress, deprivation, and emotional hardship may elevate susceptibility to addiction.