Addictive Disorders Notes

Rieger (2017) Chapter 10. Addictive Disorders from ABNORMAL PSYCHOLOGY: LEADING RESEARCHER PERSPECTIVES, 4th edition.

To be diagnosed, an individual must show at least 2 symptoms within a 12-month period that have resulted in clinically significant distress or impairment.
Symptoms include:
- Larger amounts of the substance are consumed than intended.
- Unsuccessful attempts at reducing substance use.
- A large amount of time is spent obtaining, using, and recovering from the substance.
- Strong desires or cravings to use the substance.
- Failure to fulfill role obligations due to substance use.
- Continued use despite it causing interpersonal difficulties.
- Interference with social and occupational activities.
- Use in situations that are hazardous (e.g., drunk driving).
- Continued use even though the person knows it is causing problems.

Tolerance:
- A need for increased amounts of the substance to achieve the same effect.
- Diminished effect with the same amount of substance.
Withdrawal:
- A range of symptoms that emerge after cessation of use.
- Taking a substance to alleviate these symptoms.

Comorbidity of substance use disorders and other mental disorders is a major challenge of treatment.
In Australia, approximately 35% of those with a substance use disorder also have other mental disorders.
Those with a comorbid condition have worse outcomes.

Substance use disorders are associated with increased physical problems and heightened mortality.
Older people face particular risks; they are more susceptible to the effects of alcohol, which can lead to increased mortality from falls, motor vehicle accidents, and suicide.
Substance misuse extends beyond the individual; a 2010 study reports almost 75% of Australian adults had been affected by the drinking of others.
The prevalence of harmful alcohol use among Indigenous Australians is estimated to be twice that of non-Indigenous Australians.

Adoption and twin studies suggest a strong genetic component in the development of substance use disorder.
The genetic basis of substance use disorder is thought to be non-specific.
Substances that can lead to dependence act on the brain’s reward system.
- Major reward systems: dopaminergic system and the endogenous opioid system.
Inhibition dysregulation theory: addictions result from a failure of an inhibitory system.

Traditional behavior theories focus on learning and conditioning as the basis for acquiring substance use disorders.
Classical and operant conditioning explain addictive behaviors.
Incentive-sensitization theory proposes that drugs of addiction change the areas of the brain responsible for the incentive to use the drugs.

Outcome expectancy theory: an individual’s expectation of positive consequences from substance use increases propensity to use.
Relapse prevention theory: individuals in high-risk situations will use substances if:
- They do not have appropriate coping strategies.
- They have positive expectations relating to the effects of the substance.
- They have a low degree of self-efficacy.
- Single relapse à full relapse = abstinence violation effect.

Brief interventions are generally considered most useful for those whose substance use is not yet severe.
Cognitive behavior training in a range of skills, including relapse prevention, has been associated with a good outcome.
There is some evidence for the utility of internet-based interventions.
Recovery models recognize that people start at different points, have different goals, and these goals may differ from family or society more broadly.