addictions vol 1

Foundations of Addictions Counseling

Chapter 1: History and Etiological Models of Addiction

Substance Use in the United States
The Temperance Movement and Prohibition

  • Early views framed alcohol as healthy.

  • 1784: Dr. Benjamin Rush identified alcoholism as a disease.

  • 1800s: Clergy warned that alcohol corrupted body and mind.

  • Temperance movement initially promoted moderation, later shifting to abstinence.

  • 1840: The Washingtonian Total Abstinence Society emerged, a precursor to AA.

  • Women played a major role through groups such as the Women’s Christian Temperance Movement, Daughters of Rechab, and Sisters of Sumaria.

  • 1919: The Volstead Act prohibited manufacturing and sale of alcohol.

  • Prohibition reduced consumption but increased crime and social turmoil; repealed in 1933.

  • Post-Prohibition: States regulated alcohol sales; problems were attributed to people, not substances.

  • Early 20th century: Temperance movement spread internationally.

Early Drug Use and Regulation

  • Cocaine, opium, morphine widely used in medicines.

  • These substances were legal through the 19th century; marijuana legal until 1930s; LSD legal in 1950s.

  • 1906: Pure Food and Drug Act passed.

  • 1914: Harrison Act taxed opium and coca products.

  • 1971: NIAAA established; President Nixon launched the War on Drugs.

  • 1974: NIDA created.

  • 1986: Anti-Drug Abuse Prevention Act created the U.S. Office for Substance Abuse Prevention.

  • 1990s: Focus on controlling prescription drug misuse and drug importation.

  • Recent decades: Emphasis on incarceration over prevention and treatment.

  • 2023: President Biden’s Unity Agenda prioritized addressing the opioid and overdose epidemic.

Current Policies Influencing Prevention

  • Policies emphasize punitive approaches, contributing to mass incarceration.

  • All states set minimum drinking ages and penalize sales to minors.

  • Some states maintain dry counties.

  • Alcohol pricing influenced through taxation and state-owned liquor stores.

  • Military settings may ban alcohol and tobacco.

  • DUI is a criminal offense; convictions raise insurance rates.

  • Establishments serving alcohol may be held civilly liable for harms caused by intoxicated patrons.

  • Illicit drug policies remain less specific than alcohol regulations.

  • 2000: SAMHSA reauthorized, funding integrated treatment for co-occurring disorders.

  • 2020: Oregon decriminalized drug use, shifting toward ticketing rather than incarceration.

Models Explaining the Etiology of Addiction

Moral Model

  • Addiction viewed as moral failing; no biological basis.

  • Influential in religious and legal systems.

Psychological Models

  • Cognitive-Behavioral Models: Addiction driven by cognitive and behavioral reinforcers.

  • Learning Models: Social learning shapes substance use behaviors.

  • Psychodynamic Models: Addiction linked to ego deficits, attachment issues, hostility, or early experiences.

  • Personality Models: Certain traits predispose individuals to addiction.

Family Models

  • Behavioral Model: Family members reinforce substance-using behavior.

  • Family Systems Model: Addiction maintains family roles; change disrupts system balance.

  • Family Disease Model: Addiction transmitted genetically and maintained environmentally.

Disease Model

  • Addiction is a primary, chronic, incurable disease.

  • Individuals identify as "recovering" rather than "recovered."

Public Health Model

  • Addiction results from societal influences; emphasizes promoting healthy behaviors.

Developmental Model

  • Risk and vulnerability change across the lifespan.

  • Developmental factors influence likelihood of substance misuse.

Biological Models

  • Genetic Models: Inherited metabolic defects interact with environment.

  • Neurobiological Models: Neurotransmitter systems shape addiction; includes Opponent Process and Incentive-Sensitization theories.

  • Supracultural Models: Cultural norms around guilt, aggression, and alcohol use influence addiction rates.

Culture-Specific and Subcultural Models

  • Cultural customs and attitudes shape substance use patterns.

  • Subgroups defined by age, gender, ethnicity, SES, religion, and family background show distinct patterns.

Multicausal Models

  • No single model explains addiction.

  • Etiology involves multiple interacting variables.

  • Includes Syndrome and Integral Models.

Chapter 2: Substances of Addiction

  • The age group most affected by substance use disorders is 18 to 25 years old.

  • Within the first six months of the COVID-19 pandemic, 13% of Americans reported increased substance use as a means of coping with stress and negative emotions related to the pandemic.

  • The ingestion of chemicals results in a substance use disorder for only a small subset of people.

Depressants

  • Depressants are a class of substances that cause depression of the central nervous system (CNS), generally resulting in drowsy or calming behavioral effects.

  • This depressant effect results from slowing messages between the brain and body.

  • A key neurotransmitter involved in this effect is γ-aminobutyric acid (GABA).

Alcohol

  • Ethanol, or ethyl alcohol, is the most abused mood-altering substance today.

  • Approximately 50% of people in the United States over age 12 reported alcohol use within the past month.

  • Guidelines for daily alcohol use: 2 drinks for men, 1 drink for women.

  • A common misconception is that some alcoholic beverages are safer or less addicting than others.

  • The effects of alcohol are experienced biologically for as long as the ethanol remains in the body, and the liver processes ethanol at a relatively the same rate for most people.

  • Respiratory arrest or aspiration of vomit are leading causes of death due to alcohol use.

Sedatives/Hypnotics

  • The most common drugs in this group are benzodiazepines, barbiturates, and nonbarbiturates.

  • Benzodiazepines, referred to as tranquilizers, are frequently prescribed for symptoms like sleeplessness, anxiety, muscle strains, and seizures.

  • Researchers have found that benzodiazepines such as Valium (diazepam) and Xanax (alprazolam) are highly addictive with long-term use and often have severe withdrawal complications requiring medical detoxification.

  • Barbiturates act quickly, decreasing neurotransmitter activity and depressing the CNS; they are particularly dangerous when combined with other CNS depressants like alcohol.

  • Nonbarbiturates include drugs such as Quaalude (methaqualone) that have a similar physiological profile to barbiturates.

Opioids

  • Opioids include both natural (opiates) and synthetic drugs, with examples including codeine, morphine, and heroin, as well as synthetic versions like OxyContin and fentanyl.

  • Opioids are often abused for their dramatic effects on the brain’s reward pathway.

  • The increase in opioid use has escalated substantially over the past two decades; among young adults aged 18 to 25, heroin use has doubled.

  • The increased rate of use and addiction correlates with high levels of opioid prescribing.

  • High-prescribing rates remain in small cities, large towns, and areas with higher proportions of White residents.

  • Medication-assisted therapy, such as methadone, is frequently used in the treatment of opioid addiction.

Stimulants

  • Stimulants are substances that increase brain activity primarily through the neurotransmitters dopamine and norepinephrine, involved in the reinforcement of rewards.

  • Prescription stimulants are used for ADHD and narcolepsy, aimed at boosting alertness and energy levels.

  • Misuse can lead to anger, paranoia, and psychosis; stimulant overdose can result in symptoms such as tremors, confusion, and irregular heartbeat.

  • Withdrawal can bring fatigue, depression, or sleep issues.

Nicotine

  • Nicotine is a stimulant found in tobacco products.

  • Associated dangerous health risks: increased cancers, heart disease, stroke, diabetes, and chronic respiratory illnesses.

  • Smoking and tobacco addiction lead to over six million deaths globally each year.

  • Treatment for nicotine addiction often includes medications like bupropion and varenicline.

Ephedrine, Amphetamines, and Amphetamine-Like Medications

  • Used in ancient Chinese medicine for over 5,000 years; legal use peaked in the U.S. after 1930.

  • Misuse of amphetamines can lead to severe side effects, including psychosis and death.

  • Methamphetamine is a popular variant that can be administered in various forms and is known for its highly addictive properties.

Cocaine

  • Historically, cocaine was used in medical practice starting in 1884, but epidemics of addiction led to its prohibition through the Harrison Act of 1914.

  • The rapid inhalation of cocaine results in intense cravings, making it addictive within weeks to months.

Cannabinoids

  • Marijuana is one of the most abused federally illicit drugs in the U.S., despite its growing decriminalization.

  • Tolerance, withdrawal, and dependence can develop with chronic use, though less intense than with other substances.

  • Negative effects include decreased lung capacity and psychosis complications.

Hallucinogens and Other Psychedelics

  • Examples include LSD, psilocybin, and MDMA. While hallucinogens can alter perceptions, they do not have physically addicting properties like tolerance or withdrawal symptoms.

Neurobiology and Physiology of Addiction

  • The biological basis of addiction involves activation of the reward pathways in the brain, including the ventral tegmental area (VTA), nucleus accumbens (NAc), and prefrontal cortex. Dopamine is a key neurotransmitter in this process, along with others like GABA and glutamate.

  • The addiction cycle consists of three phases:
      - Phase 1: Binge/Intoxication
      - Phase 2: Negative Affect/Withdrawal
      - Phase 3: Preoccupation/Anticipation

Chapter 3: Addictions Classification

  • Addictions can be classified as either ingestive or process addictions. Process addictions encompass behaviors producing euphoria without mood-altering substances.

  • Research indicates that physical dependence is not always necessary to diagnose an addiction.

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