View
218
Download
0
Category
Tags:
Preview:
Citation preview
ETIOLOGY OF SUBESTANCE DEPENDENCY
DR MOTAHARE MIRDAMADI
psychiatrist
Substance abuse
the excessive and compulsive use of substance
for their effect on the mind. tolerance to the drug, an increasingly higher
dose of the drug is needed. withdrawal : it will cause physical problems.
How Drugs & Alcohol Work
They interact with nerve circuits, centers, and chemical messengers Results;
I Feel Good – Euphoria & Reward I Feel “Better” – Reduce negative feelings This Feels “Normal” I’m craving it, tolerating its effects,
withdrawing and feeling sick
Common Characteristics of People Who are Addicted
Unemployed or employed Multiple or no criminal justice contacts Difficulty coping with stress or anger Highly influenced by social peer group or a
loner Difficulty handling high-risk relapse situations
or craves excitement
conscious decision or a chronic, relapsing illness
changes that occur in the brain can turn drug abuse into a chronic, relapsing illness.
More specifically, genetic factors contribute 40% to 60% to the risk for alcoholism
addicts who become dependent early in life are the most genetically predisposed to the disease
First, there is an activation of the brain's "pleasure pathway.
MULTI FACTORIAL
major questions concern the etiology of addiction, including the relative roles of genetic and environmental factors, neurochemical and neuroanatomic changes, and the course of the illness
initial drug use
Environmental factors: family's beliefs and attitudes exposure to a peer group that
encourages drug use
Risk factors:
Biologic factorEnviromentpsychologic
Environmental correlates
influences of family, peers, and availability children and adolescents. favorable attitudes or
actual use of drugs by parents absence of parental support, chaotic living
conditions, divorce or separation, and inconsistent parenting styles
coherent and consistent parenting styles are "protective" against substance abuse
Have easy access to drugs
Peer group :modeling and social reinforcement Availability: For example, living in college
dormitories versus living with parents gender :male; Although males and females self-
report similar reasons for using drugs 18 and 44 years of age unmarried lower socioeconomic status.
environmental factors
environmental factors
woman's risks for problem drinking include: the influence of her partner's drinking, her degree of depression, her sexual history (including sexual
orientation and sexual dysfunction), a history of violent victimization (physical
and sexual)
alcohol
Genes may influence traits such as impulsivity, which can make a person more likely to become alcoholic.
Genes may also influence the level of dopamine in the brain
COMMUNITY INDIVIDUAL / PEER
Availability of Drugs Alienation and Rebelliousness
Community Laws and Norms Favorable Toward Drug Use
Friends Who Engage in the Problem Behavior
Transitions and Mobility Favorable Attitudes Toward the Problem Behavior
Low Neighborhood Attachment and Community Disorganization
Early Initiation of the Problem Behavior
Extreme Economic Deprivation Constitutional Factors
FAMILY SCHOOL
Family History of the Problem Behavior
Early and Persistent Antisocial Behavior
Family Management Problems Academic Failure Beginning in Late Elementary School
Family Conflict Lack of Commitment to School
Favorable Parental Attitudes and Involvement in the Problem Behavior
Peer group
PSYCHOLOGIC FACTORS:
Have depression, bipolar disorder, anxiety disorders, and schizophrenia,PTSD
Have low self-esteem, or problems with relationships
Live a stressful lifestyle, economic or emotional
Live in a culture where there is a high social acceptance of drug use
Risk factor
Family history of addiction. the effects of many genes
Being male. twice
Having another psychological problem. depression, attention-deficit/hyperactivity disorder or post-traumatic stress disorder
Peer pressure. young people ;strong factor in starting to abuse drugs.
Lack of family involvement. A lack of attachment and lack of parental supervision.
Anxiety, depression and loneliness. coping with painful psychological feelings.
Taking a highly addictive drug heroin and cocaine
More Common Characteristics
Emotional and psychological immaturity
Difficulty relating to familyDifficulty sustaining long-term
relationshipsEducational and vocational deficits
Co-Occurring Disorders
Mood Disorder+: 24-40% have a co-occurring substance abuse disorder
Alcoholism+: 65% of females and 44% of male alcoholics have co-occurring mental health disorder(s)
THE MAJOR ONE = DEPRESSION19% of female alcoholics, 4x the rate for men
antisocial personality
nature of the substance
crack, heroin or cocaine can bring about addiction more rapidly
if a group of people were to take crack every day for six months, versus another take alcohol, the number of crack addicts would be a lot higher than the number of alcoholics.
For some people trying a substance even once can be enough to spark an addiction. Crack, also known as crack cocaine or rock, is a freebase form of cocaine that can be smoked.
start consuming a drug earlier in life have a higher risk of addiction
How the body metabolizes (processes) the substance - in cases of alcohol
Classical conditioning
physiological positive reinforcement (euphoria) social positive reinforcement (enhanced peer
status) Physiological negative reinforcement :in warding off
a withdrawal reaction Social negative reinforcement :escaping from a
noxious home, school, or vocational life. peer cluster theory
• conditioned stimuli
environmental cues are present during drug use-> drug’s behavioral and
physiological effects. With repetition the cues
become conditioned stimuli, experiences as drug
craving.
Sensitization
Withdrawal creates a craving
or desire for the drug and plays a very strong role in recurrent patterns of relapse
Sensitization occurs when the effects of a given dose of a drug increase after repeated administration.
repeated presentation of the environmental cues, absent the drug, should extinguish the conditioned association.
he emergence of withdrawal symptoms as a result of exposure to conditioned
cues can contribute to drug use relapse
cognitive It has been argued, that substance
abusers differ from others:beliefs about potential benefits of the
drug ability to cope with the stress of
everyday life
Cognitive
self-reported motivations reasons for which type of substance use: motivations for alcohol and marijuana abuse include
"getting away from problems,“ cocaine and amphetamines involve "staying alert
and awake.“ "self-medicating" motives increase with
consumption ,pain relive
Cognitive Deficits
Memory problems – short-term loss Impaired abstraction failed problem-solving strategies Loss of impulse control These deficits are similar to those with brain
damage
pleasure pathway
The mesocorticolimbic pathway from the ventral tegmental area to the nucleus accumbens and the frontal cortex is a key component of the brain reward system for drug reinforcement
Nature Video Cocaine Video
Front of Brain
Back of Brain
Amygdalais not lit up
Amygdalais activated
Personality
no evidence for "addictive personality“ distinct personality syndrome: interpersonal alienation, poor impulse control, manifest emotional distress childhood and the quality of parenting received Sensation seeking Depressed mood Low self steem
RF versus protective
Risk Factors Domain Protective Factors
Early Aggressive Behavior Individual Self-Control
Lack of Parental Supervision Family Parental Monitoring
Substance Abuse Peer Academic Competence
Drug Availability School Anti-drug Use Policies
Poverty Community Strong Neighborhood Attachment
prevention efforts
Family Management ProblemsFavorable Attitudes Toward the
Problem BehaviorSocial Skills (protective)Bonding (protective)
Persons Risk Factors Protective factors
Individual Behavioral disengagement copingNegative emotionalityConduct disorderFavorable attitudes toward drugsRebelliousnessEarly substance useAntisocial behavior
Positive physical developmentEmotional self-regulationHigh self-esteemGood coping skills and problem-solving skillsEngagement and connections in two or more of the following contexts: at school, with peers, in athletics, employment, religion, culture
Adolescence
Persons Risk Factors Protective factors
Individual Difficult temperament Self-regulationSecure attachmentMastery of communication and language skillsAbility to make friends and get along with others
Family Cold and unresponsive mother behavior Parental modeling of drug/alcohol use
Reliable support and discipline from caregiversResponsivenessProtection from harm and fearOpportunities to resolve conflictAdequate socioeconomic resources for the family
School, Peers, Community
Support for early learningAccess to supplemental services such as feeding, and screening for vision and hearingStable, secure attachment to childcare providerLow ratio of caregivers to childrenRegulatory systems that support high quality of care
Infancy/Early Childhood
Family Substance use among parentsLack of adult supervisionPoor attachment with parents
Family provides structure, limits, rules, monitoring, and predictabilitySupportive relationships with family membersClear expectations for behavior and values
School, Peers, Community
School failureLow commitment to schoolAssociating with drug-using peersNot college boundAggression toward peersNorms (e.g., advertising) favorable toward alcohol useAccessibility/ availability
Presence of mentors and support for development of skills and interestsOpportunities for engagement within school and communityPositive normsClear expectations for behaviorPhysical and psychological safety
Age of onset
Alcohol and drug use tends to begin in mid-to-late adolescence, though it is greater among individuals who experience early puberty .. A delay in drinking until 20- to 21-years-old reduces the risk of developing alcohol-related problems Youth perception that parents approve of their alcohol or drug use
One of the most consistent risk factors for adolescent drinking is perceived parental approval (Donovan, 2004). Reported maternal care perception has been shown to be significantly lower among alcohol and those who use multiple drugs (Gerra et al, 2004).
Peers engaging in problem behavior
Associating with drug- or alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell et al, 2009). Exposure to peer problem behavior is correlated with increased alcohol and other substance use in the same month (Dishion et al, 2000). Those who drink in a social setting, or who have peers who do so, are more likely to abuse alcohol later in life (Beck et al, 1996).
Early and persistent problem behaviors, risk-taking, and high sensation-seeking
Early aggressiveness or antisocial behavior persisting into early adolescence predicts later adolescent aggressiveness, drug abuse, and alcohol problems (Hawkins et al, 1995).
Parental monitoring (or perception of monitoring)
Adolescents who report low parental monitoring are significantly more likely to use a variety of substances (Shillington et al, 2005). Positive parental style and close monitoring by parents are proven protective factors for adolescent’s use of alcohol and other drugs (Stewart, 2002).
Parent or older sibling drug use (or perception of use)
Familial alcohol-using behaviors are strong predictors of adolescent alcohol use (Birckmayer et al, 2004). In a 2003 study, alcohol initiation most often occurred during family gatherings. Moreover, a family history of alcoholism was a significant risk factor for the development of adolescent problem drinking (Warner et al, 2003).
Low perception of harm
Low perception of harm towards alcohol and drug use is a risk factor for use (Henry et al, 2005). Individuals with attitudes or values favorable to alcohol or drugs are more likely to initiate substance use
Strong parent and adolescent relationship and family cohesion
Adolescents who have a close relationship with their parents are less likely to become alcohol involved (Birckmayer et al, 2004).
Youth access and availability
The majority of alcohol consumed by youth is obtained through social sources, such as parents and friends, at underage parties and at home (Birckmayer et al, 2004). Availability of alcohol or illegal drugs leads to increased use (Hawkins et al, 1995).
Poor school achievement and low school bonding
Adolescents who have a low commitment to school or do poorly are more likely to become alcohol involved
Recommended